title: Mechanism of action and effect of immune-modulating agents in the treatment of psoriasis.
abstract: OBJECTIVE
  The aim of this work is to study the possible mechanisms through which different immune-modulating agents can produce their beneficial effects on treatment of psoriasis and to determine whether the supplementation of these agents for psoriasis patients induces regression of psoriasis.
  
  
  METHODS
  One hundred fifty participants were included in this study. The participants were divided into five groups: 1. Normal control group, 2. Psoriasis patients not taking any treatment, 3. Psoriasis patients treated with anti-psoriatic treatment (including coal tar, vitamin D3 analogues and corticosteroids). 4. Psoriasis patients treated with anti-psoriatic treatment and oral metformin (850mg twice daily) and 5. Psoriasis patients treated with anti-psoriatic treatment and oral pioglitazone (15mg once a day). Demographic characteristics, diabetic index, lipid profile and liver function tests were monitored. The CD4+ Tcells, CD8+ Tcells, CD4+/CD8+ ratio, interleukin-2 (IL-2), C-reactive protein (CRP) and ceruloplasmin (CP) were assayed.
  
  
  RESULTS
  After treatment of psoriasis patients with a traditional anti-psoriatic drug in combination with metformin and peroxisome proliferator-activated receptor gamma (PPARɤ) agonist (pioglitazone), the CD4+ T cells, IL-2, CRP, CP, ALT and AST levels were statistically significantly decreased compared to psoriasis patients without treatment. Positive and significant correlations between CD4+ % and IL-2, CRP, CP, ALT and AST in psoriasis patients were recorded.
  
  
  CONCLUSIONS
  The activation of PPAR-γ receptors by pioglitazone results in reduced formation of the proinflammatory cytokines and infiltration by inflammatory cells. Additionally, metformin acts as a modulator of the immune system in psoriasis patients and has a remarkable effect on the early stages of psoriasis. Therefore, either pioglitazone or metformin in combination with traditional anti-psoriatic drugs provides better results in the treatment of psoriasis than does each alone.
authors.affiliation: Pharmacology and Toxicology Department, College of Pharmacy, Qassim University, Saudi Arabia; Pharmacology and Toxicology Department, College of Pharmacy, Tanta University, Egypt. Electronic address: drrehab200932@yahoo.com.
authors.forename: Rehab M
authors.initials: RM
authors.lastname: El-Gharabawy
authors.affiliation: Pharmacology and Toxicology Department, College of Pharmacy, Qassim University, Saudi Arabia; Hormone Department, National Research Center, Egypt.
authors.forename: Amira S
authors.initials: AS
authors.lastname: Ahmed
authors.affiliation: Pharmacy Services, Security Forces Hospital, Riyadh, Saudi Arabia.
authors.forename: Amal H
authors.initials: AH
authors.lastname: Al-Najjar
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D002762:Cholecalciferol / Q000031:analogs & derivatives / Q000627:therapeutic use; D003033:Coal Tar / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D000077205:Pioglitazone; D011565:Psoriasis / Q000188:drug therapy* / Q000276:immunology; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D007004:Hypoglycemic Agents; D007155:Immunologic Factors; D045162:Thiazolidinediones; D002762:Cholecalciferol; D003033:Coal Tar; D008687:Metformin; D000077205:Pioglitazone
keywords: Autoimmune disease; C-reactive protein; CD4+ T cells; CD8+ T cells; Ceruloplasmin; Interleukin-2; Metformin; Pioglitazone; Psoriasis