Relationship between disease severity and fetuin-A levels in patients with psoriasis

Wafaa Ahmed Shehata¹ , Mohamed Ahmed Basha¹ , Iman Masoud Gayed² , Shaimaa Basyouny Elhagary³

¹ Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Al- Menoufia, Egypt
² Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Al- Menoufia, Egypt
³ Ministry of Health, Shebin El-kom, Al- Menoufia, Egypt

Correspondence Address:
Wafaa Ahmed Shehata
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Shibeen EL - Koom, 32817 Menoufia Governorate
Egypt

Sir,

Psoriasis is a chronic inflammatory disease with associated comorbidities such as psoriatic arthritis, cardiovascular disorders and inflammatory bowel diseases. Psoriasis results from an interplay of genetic susceptibility, skin barrier defect and dysregulation of innate and adaptive immunity.^[1]

Fetuin-A is a negative acute-phase protein. Its level decreases during acute and chronic inflammation, suggesting that it may have an anti-inflammatory effect. This is possibly due to inhibition of release of active high-mobility group box protein 1 and subsequent cytokine expression.^[2]

This cross-sectional study was conducted at Dermatology, Andrology and Sexually Transmitted Diseases and Medical Biochemistry Departments, Menoufia University, Shebin EL-Kom, Egypt.

The aim of this study was to evaluate the serum level of fetuin-A in patients with psoriasis vulgaris compared to controls and to correlate it with the disease severity.

Forty patients with variable degrees of psoriasis severity who were assessed by psoriasis area and severity index score were selected. Patients with any skin disease other than psoriasis vulgaris were excluded.

Forty healthy and age- and gender-matched subjects were enrolled as a control group. A written consent form approved by a local ethical research committee was obtained from every participant before enrolling in the study.

The serum level of fetuin-A was measured by enzyme-linked immunosorbent assay. The statistical analysis was done using a Statistical Package of Social Science (SPSS) version 22. The following statistics were calculated: mean (X¯), standard deviation (SD), range, number (n), percentage (%), Student's t-test (t), chi-square test (χ2) and Pearson's correlation test (r). P value < 0.05 was considered statistically significant.

Basic demographic and clinical profiles of the subjects are given in [Table - 1]. Mean serum levels of fetuin-A was 198.88 ± 31.61 mg/dL (range 142.9–248.2 mg/dL) among the cases compared to 480.44 ± 36.23 mg/dL (range 229.7–551.1 mg/dL) in the control group (P < 0.001). There was no significant correlation between serum level of fetuin-A and psoriasis area and severity index score (r = -0.18 and P = 0.274). Mean serum level of high-sensitive C-reactive protein was 4.44 ± 1.11 mg/dL among the cases (range 1.6–5.9 mg/dL) compared to 1.55 ± 0.64 mg/dL (range 0.63–2.54 mg/dL) among the control group (P < 0.001).

Gerdes et al. reported that serum fetuin-A levels were elevated in the control group compared with patients with psoriasis.^[3] They hypothesized that inflammation in patients with psoriasis resulted in decreased fetuin-A levels and inflammatory mediators like interleukin-6 and interleukin-1β can reduce fetuin-A gene expression.

Ataseven et al. reported that serum fetuin-A levels were significantly decreased in psoriatic patients compared to healthy control group members.^[4] They also concluded that the serum level of fetuin-A did not correlate with the psoriasis area and severity index score. Uysal et al. reported a significant positive correlation between the mean serum level of fetuin-A and psoriasis area and severity index score and also suggested that there is a possible link between the underlying systemic inflammatory pathways involved in psoriasis, fetuin-A levels and the development of comorbid diseases.^[1]

In our study, the serum level of high-sensitive C-reactive protein was higher among cases compared with those in the control group. Ataseven et al. reported an inverse relationship between serum levels of fetuin-A and C-reactive protein in the serum of psoriatic patients.^[4] Uysal et al. reported that the serum C-reactive protein level increased in psoriatic patients more so in severe cases.^[1] Tumour necrosis factor -alpha and interleukin-6 were postulated to contribute to the formation of psoriatic and atherosclerotic plaques as well as the increase in the release of C-reactive protein.^[5]

Our results showed that serum fetuin-A levels are low in patients with psoriasis however, it is not related to disease severity. Further studies on the role of fetuin-A may throw more light on the pathogenesis of psoriasis.

Limitations of the study

The main limitation of this study was the small sample size followed by the fact that the patient selection did not reflect the general population, as the study was done in a single clinic.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) have given their consent for their images and other clinical information to be reported in the journal. The patients understands that their names and initials will not be published and due efforts will be made to conceal their identity but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1.	Uysal S, Yılmaz FM, Karatoprak K, Artüz F, Cumbul NU. The levels of serum pentraxin3, CRP, fetuin-A, and insulin in patients with psoriasis. Eur Rev Med Pharmacol Sci 2014;18:3453-8. [Google Scholar]
2.	Tuttolomondo A, Di Raimondo D, Di Sciacca R, Casuccio A, Bivona G, Bellia C, et al. Fetuin-A and CD40 L plasma levels in acute ischemic stroke: Differences in relation to TOAST subtype and correlation with clinical and laboratory variables. Atherosclerosis 2010;208:290-6. [Google Scholar]
3.	Gerdes S, Osadtschy S, Buhles N, Baurecht H, Mrowietz U. Cardiovascular biomarkers in patients with psoriasis. Exp Dermatol 2014;23:322-5. [Google Scholar]
4.	Ataseven A, Kesli R, Akyurek FT, Kurtipek GS, Dursun R. Decreased serum levels of alpha-2-heremans schmid glycoprotein (fetuin-a) in patients with psoriasis. Aperito J Dermatol 2015;2:111. [Google Scholar]
5.	Ghazizadeh R, Shimizu H, Tosa M, Ghazizadeh M. Pathogenic mechanisms shared between psoriasis and cardiovascular disease. Int J Med Sci 2010;7:284-9. [Google Scholar]