Role of high-mobility group box-1 as a marker of disease severity and diagnosis of metabolic syndrome in psoriatic patients

Abstract

Background Psoriasis is a chronic inflammatory disease with systemic immunological disturbance. Suggested pathophysiology linking psoriasis and metabolic syndrome involves overlapping inflammatory and genetic pathways. High-mobility group box-1 (HMGB1) is a nuclear transcriptional protein, which is released extracellularly to function as a proinflammatory mediator. Elevated HMGB1 was reported in autoimmune and inflammatory disorders. However, its role in inflammatory dermatological conditions such as psoriasis is under investigation. Objectives The goals of this study were to evaluate the serum level of HMGB1 in psoriasis patients and its relation to disease severity. In addition, the study aimed to compare its level between psoriatic patients with and without metabolic syndrome with assessment of its prognostic potential to diagnose metabolic syndrome in the psoriatic population. Patients and methods Fifty psoriatic patients and 20 healthy controls were included. Serum level of HMGB1 was measured using enzyme-linked immunosorbent assay and its relation to disease severity and duration using psoriasis area and severity index. Metabolic syndrome was identified among psoriatic patients, using International Diabetes Foundation. Receiver operating characteristic analysis was employed to calculate the area under the curve for HMGB1 to find the best cutoff value capable of diagnosis of metabolic syndrome in psoriasis. Results Significantly higher HMGB1 level in psoriasis patients than in controls was detected (P=0.037) and was correlated with disease severity. A higher HMGB1 level among psoriatic patients with metabolic syndrome than that among patients without metabolic syndrome was reported (P=0.007). At receiver operating characteristic analysis, HMGB1 showed 80% sensitivity and 50.43% specificity in detecting metabolic syndrome in psoriasis. Conclusion HMGB1 may be considered as a useful marker of psoriasis severity in addition to its predicting potential for metabolic syndrome in psoriatic patients.