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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 3  |  Page : 993-997

The value of elevated serum resistin levels as a diagnostic marker in psoriasis


1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Dermatology, Andrology and STDs, Menoufia General Hospital, Menoufia, Egypt

Date of Submission28-Oct-2018
Date of Decision19-Nov-2018
Date of Acceptance25-Nov-2018
Date of Web Publication30-Sep-2020

Correspondence Address:
Sara E. S. Matar
Menouf City, Menoufia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_337_18

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  Abstract 


Objective
The objective of this study was to assess the value of elevated serum resistin levels as a diagnostic marker in psoriasis.
Background
Psoriasis is a chronic, recurrent, immune-mediated, inflammatory skin disease. Hormonal as well as metabolic factors may play a role in the pathogenesis of psoriasis. Resistin is an adipose tissue-derived adipokine and is linked to inflammation, immunity, obesity, and insulin resistance. Resistin is considered to be important modulator of chronic inflammation contributing to the development of many disorders, including psoriasis. Several studies have showed that resistin and psoriasis are positively correlated.
Patients and methods
This case–control study was conducted on 34 patients: 17 patients with psoriasis and 17 age-matched and sex-matched healthy controls during the period from November 2017 to March 2018. All patients were subjected to full history taking, clinical examination, and laboratory investigations. Serum resistin levels were measured by using enzyme-linked immunosorbent assay technique.
Results
Serum resistin levels were significantly elevated in patients with psoriasis (22.96 ± 14.90) compared with healthy controls (10.66 ± 2.57). There was a significant positive correlation between serum resistin level and each of Psoriasis Area and Severity Index score (r = 0.821, P < 0.001) and duration of disease (r = 0.872, P < 0.001).
Conclusion
Serum resistin levels were higher in patients with psoriasis compared with healthy controls. The levels were correlated with clinical severity in patients with psoriasis. Therefore, serum resistin level can be used as a diagnostic biomarker for evaluating the clinical status of patients with psoriasis and may predict the occurrence of co-morbidities in patients with psoriasis.

Keywords: biomarker, enzyme-linked immunosorbent assay, psoriasis, resistin, skin disease


How to cite this article:
El-Farargy SM, Ghanayem NM, Matar SE. The value of elevated serum resistin levels as a diagnostic marker in psoriasis. Menoufia Med J 2020;33:993-7

How to cite this URL:
El-Farargy SM, Ghanayem NM, Matar SE. The value of elevated serum resistin levels as a diagnostic marker in psoriasis. Menoufia Med J [serial online] 2020 [cited 2020 Oct 22];33:993-7. Available from: http://www.mmj.eg.net/text.asp?2020/33/3/993/296664




  Introduction Top


Psoriasis is a chronic, recurrent, immune-mediated disease of the skin and joints that may negatively affect physical, emotional, and psychosocial well-being of affected patients [1]. Psoriasis prevalence in ~1–3% of the total population [2]. The etiology of psoriasis is unknown but the disease is believed to have an autoimmune basis and a strong genetic component [3]. Hormonal as well as metabolic factors may play a role in the pathogenesis of psoriasis supported by early onset of psoriasis in women, with a peak around puberty, changes during pregnancy, and provocation of psoriasis by high-dose estrogen therapy. In primates, pigs, and dogs, resistin is secreted by immune and epithelial cells. However, in rodents, it is secreted by adipose tissue [4]. It is clinically manifested by well-demarcated erythematous plaques with adherent silvery scales. Clinical types include plaque psoriasis, guttate psoriasis, erythrodermic psoriasis, psoriatic arthritis, and pustular psoriasis. Psoriasis vulgaris is the most common variant of psoriasis, representing ~70–80% of patients with psoriasis. Psoriasis Area and Severity Index (PASI) score is the most widely used tool for assessment of the severity of psoriasis. Adipose tissue is not only an energy-storing organ but also a major source of adiopkines such as adiponectin, leptin, tumor necrosis factor-α, and resistin [5]. Resistin is an adipose tissue-derived adipokine that is linked to inflammation, immunity, obesity, and insulin resistance [6]. Resistin is a 12.5-kDa polypeptide that belongs to the inflammatory zone protein family [7]. Resistin is a cysteine-rich protein primarily produced by peripheral blood mononuclear cells in humans and white adipose tissue in rodents [8]. Resistin was found to serve endocrine functions and is likely involved in insulin resistance [9]. Serum resistin regulates insulin sensitivity and glucose metabolism and is a moderator between diabetes and obesity, exhibiting a positive correlation with BMI [10]. High serum resistin levels are observed in patients with psoriasis [11]. Therefore, it is possible that in addition to the involvement of resistin in metabolic syndrome, resistin may also directly affect pathogenesis of psoriasis [12]. Resistin level may be useful as a biomarker for diagnosis of psoriasis and to adjust the treatment regimen during fluctuating severity of the disease [5]. The aim of this study was to assess the value of elevated serum resistin level as a diagnostic marker in psoriasis.


  Patients and Methods Top


Study population and selection of patients

This study was approved by the Ethical Committee of Dermatology, Andrology and STDs, and Medical Biochemistry Departments, Faculty of Medicine, Menoufia University, during the period from November 2017 to March 2018. Informed consent was obtained from every patient and control. It included 34 patients: 17 patients with chronic psoriasis (group 1) and 17 age-matched and sex-matched healthy controls (group 2). Exclusion criteria included patients on topical or systemic therapy for psoriasis during the last 3 months before the study and other skin conditions precluding proper assessment of psoriasis severity. The patients were subjected to the following: (i) full history including personal, family, and clinical history of psoriasis (onset, course, duration, and presence of itching); (ii) clinical examination: general and dermatological examination which include distribution of lesion, koebnerization, presence of nail affection, scalp affection, joint affection, and severity of psoriatic lesions, which is assessed according to PASI score; and (iii) laboratory investigations.

Collection of blood samples

Peripheral venous blood samples (5 ml) were withdrawn from every patient under complete aseptic condition into plain tubes. After clot formation, centrifugation of samples at 2000g for 10 min was done, and serum were separated and stored at −20°C until analysis of resistin. Serum resistin level was measured by enzyme-linked immunosorbent assay (ELISA) using human resistin ELISA kit provided by Sunred Company (Shangai, China). The kit uses a double-antibody sandwich-ELISA to assay the level of human resistin in samples. Resistin is added to monoclonal antibody enzyme well, which is precoated with human resistin monoclonal antibody, and then incubation is performed. Then, resistin antibodies labeled with biotin are added, which combine with streptavidin-HRP to form immunocomplex. Then incubation is carried out, followed by washing again to remove the uncombined enzyme. Then chromogen solutions A and B are added. The color of the liquid changes into blue, and with the effect of the acid, the color finally becomes yellow. The chroma of color and the concentration of the human substance resistin of sample were positively correlated.

Statistical analysis

Data were fed to the computer and analyzed using IBM SPSS software package, version 20.0. (IBM Corp., Armonk, New York, USA). Qualitative data were described using number and percentage. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level. The used tests were χ2-test, Monte-Carlo correction, F-test (analysis of variance), Kruskal–Wallis test, and receiver operating characteristic curve.


  Results Top


The mean age was 43.24 ± 21.08 years in group 1 (patients) and 37.41 ± 17.68 years in group 2 (controls). There was no significant difference between studied groups regarding age and sex [Table 1]. There was a statistically significant increase of serum resistin level in patients (group 1) compared with controls (group 2) [Figure 1]. Moreover, there was no significant difference between patients with mild psoriasis and those with moderate psoriasis regarding resistin and PASI score. There was a significant difference between severe psoriasis and each of mild and moderate psoriasis [Table 2]. There was a significant positive correlation between serum resistin level and each of duration of disease and PASI score in patient group (P < 0.001) [Table 3]. Regarding sensitivity and specificity for resistin to diagnosis patients versus control, at cutoff value of more than 13.15 ng/ml, serum resistin had sensitivity of 64.71, specificity of 88.24, positive predictive value of 84.6, and negative predictive value of 71.4 [Table 4].
Table 1: Statistical comparison between the two studied groups regarding demographic criteria

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Figure 1: Comparison between the two studied groups regarding serum resistin.

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Table 2: Statistical comparison of resistin, Psoriasis Area and Severity Index score regarding severity of psoriasis

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Table 3: Correlation coefficient between serum resistin and each of duration (years) and Psoriasis Area and Severity Index

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Table 4: Agreement (sensitivity and specificity) for resistin to diagnose patients versus control

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  Discussion Top


Psoriasis is a chronic, recurrent, immune-mediated inflammatory skin disease affecting 1–3% of world population. High serum resistin levels are observed in patients with psoriasis [11]. Therefore, it is possible that in addition to the involvement of resistin in metabolic syndrome, resistin may also directly affect pathogenesis of psoriasis [12]. The aim of this study was to evaluate the value of elevated serum resistin levels as a diagnostic marker in psoriasis. For this purpose, 34 patients were included in this study and classified into two groups: group 1 included 17 patients with psoriasis and group 2 included 17 age-matched and sex-matched healthy persons as controls.

This study showed that there was a nonsignificant difference between patients and controls regarding age and sex. This agrees with Dikbas et al. [13]. Similarly, 40 patients with psoriasis vulgaris were included in the study by Hussein et al. [14]. Moreover, 40 age-matched healthy persons were included as controls, with no difference in demographic data between the groups [14].

In this study, there is a statistically significant difference between patient and control groups regarding serum resistin level. This was in line with Kaur et al. [15]. Huang et al. [16] concluded that serum resistin in patients with psoriasis is higher than healthy controls and raises the possibility that elevated serum resistin levels may predict the occurance of comorbidities in patients with psoriasis. Zbaar [17] reported that resistin has an important role in the development of psoriasis lesion. The expression of resistin in patients with psoriasis may explain features of psoriasis that link keratinocyte proliferation with immune activation and insuline resistance. Resistin correlates with psoriasis and can be used as a potential biomarker for psoriasis and response to the treatment correspondingly. Vachatova et al. [18] concluded that selected inflammatory and anti-inflammatory markers (C-reactive protein, adiponectin, leptin, resistin, and LP-PLA2) are involved in both pathogenesis of metabolic syndrome and pathogenesis of psoriasis.

This study showed that there was a significant positive correlation between serum resistin level and each of PASI score and duration of disease. This agrees with the results of Rajappa et al. [19]. Coimbra et al. [20] observed that in the active stage of the disease, before starting a therapy, patients presented statistically significantly higher resistin level. Huang et al. [16] also concluded that elevated serum resistin levels strongly correlated with psoriasis progression, and serum resistin level could be a valuable biomarker in evaluating the clinical status of patients with psoriasis, indicating that resistin might be a potential biomarker for diagnosis and prognosis in patients with psoriasis. Moreover, Hamminga et al. [21] showed that resistin plays a predominant role in the pathogenesis of psoriasis, particularly in obese patients, which is in concordance with the results of this study. In the study conducted by Kawashima et al. [22] the percent reduction in the PASI score correlated with the percent reduction in serum resistin levels (r = 0.44, P = 0.01). The correlation between resistin concentration and PASI score was found to be positively and significantly correlated with P value of 1 × 10-7 and 1 × 10-8 for male and female patient groups, respectively, in the study by Al-Mukhtar [23]. In the study by Hussein et al. [14], estimation of serum levels of resistin in a sample of Egyptian psoriatic patients and controls revealed a significant increase of serum level of resistin among patients with psoriasis than in controls and correlated with the disease parameters, including PASI, age, disease duration, and BMI. When comparing resistin level between mild and moderate to severe psoriasis, they found significantly higher levels with increasing PASI score.

This study found a significant statistical increase in serum resistin levels in patients with severe psoriasis compared with those of mild and moderate psoriasis. This is consistent with the results of Coimbra et al. [20], who concluded that there is an association between adipokines level and psoriasis severity. There was a significant increase in resistin levels in severe cases of psoriasis than those of mild-to-moderate cases (P ≤ 0.001). It was concluded that serum resistin is elevated in patients with the skin form of psoriasis but without joint involvement, and it correlates with the disease severity as assessed by the PASI [24].

Thia study reported cutoff point of resistin of 13.15 ng/ml for diagnosis of patients with psoriasis from controls, with sensitivity of 64.71, specificity of 88.71%, positive predictive value of 84.6 and negative predictive value of 71.4%. The 95% confidence interval was 0.609–0.941. For diagnosis of mild versus moderate cases, PASI score is better than serum resistin, whereas for diagnosis of moderate versus severe cases, serum resistin is similar to PASI score with sensitivity and specificity of 100%. Takahashi et al. [5] found that the plasma levels of resistin significantly decreased after the treatment of patients with psoriasis accompanied with the decrease in PASI score. This finding suggests that resistin is an adequate evaluation marker of the psoriasis treatment.

It was demonstrated that resistin induced CXCL8 and tumor necrosis factor-α in blood monocytes; both are significantly involved in the pathophysiology of psoriasis. Therefore, the increased plasma levels of resistin in psoriasis might contribute to the effector molecules involved in psoriasis [24]. A study performed by many studies found that the severer psoriasis forms presented significantly higher values when compared with moderate forms and controls. The PASI score was found to correlate with serum resistin concentrations [25].


  Conclusion Top


From this study, we can conclude that serum resistin levels were significantly elevated in patients with psoriasis compared with healthy controls. The levels were correlated with clinical severity in patients with psoriasis. Therefore, serum resistin level can be used as a diagnostic biomarker for evaluating the clinical status of patients with psoriasis. Another study on a larger population is necessary to confirm the relationship between serum resistin levels and psoriasis.

Recommendations

From this study, we recommend that another study on a larger population is necessary to confirm the relationship between serum resistin levels and psoriasis. Further studies are required to compare the therapeutic effect of different treatment modalities on the serum and tissue resistin levels in psoriasis. Clinical trials should be conducted to evaluate anti-resistin as a therapeutic tool in psoriasis management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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