Psoriasis, Cardiovascular Events, and Biologics: Lights and Shadows.
Psoriasis, Cardiovascular Events, and Biologics: Lights and Shadows.
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DOI：
10.3389/fimmu.2018.01668
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发表时间：
2018
影响因子：
7.3
通讯作者：
Balato A
中科院分区：
文献类型：
--
作者：
Caiazzo G;Fabbrocini G;Di Caprio R;Raimondo A;Scala E;Balato N;Balato A
如今，银屑病与心血管 (CV) 疾病之间的联系已得到充分证实。一系列不同的重叠机制，包括炎症、稳态失调和遗传易感性，被认为是这种关联的基础。对银屑病复杂情况所涉及的分子模式的了解的进展突显了银屑病与动脉粥样硬化的密切相关性。事实上，在炎症细胞因子和细胞类型方面有共同的特征。在过去的十年中，随着肿瘤坏死因子-α (TNF-α)、白细胞介素 (IL)-12/23 和 IL-17 抑制剂等生物疗法的引入，银屑病患者的治疗发生了革命性的变化。在临床环境中，这些疗法的有效性以及心血管事件的发生率与生物制剂的类型有关。特别是，抗 TNF-α 药物似乎可以减少银屑病患者的这些事件，而抗 IL-12/23 药物相关的 CV 事件减少仍有待澄清。必须考虑到 IL-12/23 抑制剂的上市后监测期较短。抗 IL-17 药物的观察时间甚至更有限。 IL-17 与牛皮癣、血管疾病和炎症有关。然而，IL-17 在动脉粥样硬化中的作用仍存在争议，根据具体情况发挥促动脉粥样硬化和抗动脉粥样硬化作用。在这篇综述中，我们将讨论银屑病患者心血管事件发生之间的差异，涉及特定的生物治疗和潜在的免疫学机制。鉴于新治疗策略的发展，研究这些抑制剂对心力衰竭结局的影响极其重要。
Nowadays, it is well established a link between psoriasis and cardiovascular (CV) diseases. A series of different overlapping mechanisms including inflammation, homeostasis dysregulation, and genetic susceptibility are thought to underlie this association. Advances in understanding the molecular patterns involved in the complex scenario of psoriasis have highlighted a tight correlation with atherosclerosis. Indeed, common profiles are shared in term of inflammatory cytokines and cell types. In the last decade, the management of psoriasis patients has been revolutionized with the introduction of biological therapies, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-12/23, and IL-17 inhibitors. In clinical setting, the effectiveness of these therapies as well as the incidence of CV events is related to the type of biologics. In particular, anti-TNF-α agents seem to reduce these events in psoriasis patients whereas anti-IL-12/23 agents related CV events reduction still remain to clarify. It has to be taken into account that IL-12/23 inhibitors have a shorter post-marketing surveillance period. An even more restricted observational time is available for anti-IL-17 agents. IL-17 is associated with psoriasis, vascular disease, and inflammation. However, IL-17 role in atherosclerosis is still debated, exerting both pro-atherogenic and anti-atherogenic effects depending on the specific context. In this review, we will discuss the differences between the onset of CV events in psoriasis patients, referred to specific biological therapy and the underlying immunological mechanism. Given the development of new therapeutic strategies, the investigation of these inhibitors impact on heart failure outcome is extremely important.
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