ORIGINAL ARTICLE Year : 2022  |  Volume : 42  |  Issue : 2  |  Page : 110-114

Assessment of serum fatty acid-binding protein 4 and adiponectin levels in psoriasis patients and their correlation with disease severity

Noha Z Tawfik1, Amal H.A. Gomaa1, Ranya Hassan2, Basma A El-alfy1, Sara A Rageh1, Nader A Ismail1
1 Department of Dermatology and Venereology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Date of Submission21-Sep-2021Date of Decision12-Oct-2021Date of Acceptance25-Oct-2021Date of Web Publication19-May-2022

Correspondence Address:
MD Noha Z Tawfik
Department of Dermatology and Venereology, Faculty of Medicine, Suez Canal University, Ismailia, 41611
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ejdv.ejdv_40_21

Background Psoriasis is a chronic multifactorial autoimmune disease that has significant impacts on the quality of life. Adiponectin exhibits important anti-inflammatory, antioxidants, and antidiabetic effects. The role of fatty acid-binding protein 4 (FABP4) in psoriasis may be linked to tumor necrosis factor-α, which is one of the main cytokines contributing to the etiopathogenesis of this disease.
Aim To understand the role of serum levels of FABP4 and adiponectin in disease pathogenesis and their correlation to disease severity.
Patients and methods A case–control study was conducted on two groups. The first group included 35 psoriatic patients; the second group included 35 healthy volunteers matched for age, sex, and weight. Serum FABP4 and adiponectin levels were evaluated.
Results The mean level of adiponectin among the patients was 4.3±1.4 ng/dl. The mean level of FABP4 among controls was 2.1±1.5 ng/dl. The difference between both groups was statistically significant (P<0.05).
Conclusion In this study, serum FABP4 level and adiponectin levels were decreased in patients with psoriasis with no relation to disease severity. So, they cannot be used as clinical biomarkers of inflammation and disease activity in psoriasis

Keywords: adiponectin, fatty acid-binding protein 4, psoriasis

How to cite this article:
Tawfik NZ, Gomaa AH, Hassan R, El-alfy BA, Rageh SA, Ismail NA. Assessment of serum fatty acid-binding protein 4 and adiponectin levels in psoriasis patients and their correlation with disease severity. Egypt J Dermatol Venerol 2022;42:110-4
How to cite this URL:
Tawfik NZ, Gomaa AH, Hassan R, El-alfy BA, Rageh SA, Ismail NA. Assessment of serum fatty acid-binding protein 4 and adiponectin levels in psoriasis patients and their correlation with disease severity. Egypt J Dermatol Venerol [serial online] 2022 [cited 2022 May 22];42:110-4. Available from: http://www.ejdv.eg.net/text.asp?2022/42/2/110/345271   Introduction 

Psoriasis is an inflammatory multifactorial disease, affecting more than 2% of the world’s population [1]. Recently, psoriasis is considered a systemic disorder as it may be accompanied with metabolic syndrome, coronary artery disease, diabetes mellitus, hypertension, obesity and atherosclerosis [2]. The risk of developing diabetes, metabolic syndrome, or obesity could occur in more than 40% of psoriatic patients. Common links emerge from genetic basis, immune disorders, metabolic tissues (metaflammation), and bioactive substances, which are synthesized and secreted by the adipose tissue such as adiponectins and fatty acids [2],[3].

Fatty acids have a crucial role in maintaining permeability of the epidermis. Alterations in composition of fatty acid in keratinocytes could contribute to the pathogenesis of different inflammatory dermatoses such as atopic dermatitis or psoriasis [4]. Fatty acid-binding proteins (FABP), first detected in 1972, are a 14–15 kDa family of cytosol proteins that participate in the regulation of trafficking of lipids and protection against excessive accumulation of fatty acid [5].

Adipocyte FABP, also termed as adipocyte protein 2, is considered an adipokine that is synthesized and released from adipocytes and may be produced in endothelial cells and macrophages [3]. FABP isoforms may act as indicators of damage of organs and consequently have a role in the development of different systemic diseases [3].

Increased levels of FABP4 have contributed to the development of diabetes mellitus, obesity, atherosclerosis, and hypertension [6]. The role of FABP4 in psoriasis may be linked through tumor necrosis factor-α, which is one of the main cytokines contributed to the etiopathogenesis of this disease [6]. FABP4 has been related to vascular endothelial growth and angiogenesis, which are disturbed in psoriasis [3].

White adipose tissue is considered not only as an energy-storing organ, but also as a metabolically active source of various substances, such as adipokines. Adiponectin is an adipocyte-deprived hormone that is produced mainly by subcutaneous fat; it exhibits important anti-inflammatory, antioxidants, and antidiabetic effects. Adiponectin inhibits proinflammatory cytokines and induces anti-inflammatory ones, and it downregulates adhesion molecule expression, and it has been found to improve defects in glucose metabolism by increasing insulin sensitivity [7]. Adiponectin may inhibit the excessive inflammatory process thereby playing a role in preventing the development of psoriatic lesions that additionally supported by the treatment [8].

The data from the literature regarding associations between adipokines and psoriasis are limited. Until now, epidermal FABP has been linked with psoriasis; though, there is still lack of research on other types of FABP in psoriasis. Therefore, we aimed in this study to evaluate the level of adipocyte FABP and adiponectin is psoriasis and their relation to disease activity.

  Patients and methods 

This case–control study included 35 patients with psoriasis (group I), who were recruited from the Dermatology Outpatient Clinics and 35 apparently healthy people from blood bank donation center with matched age, sex, and weight, which served as a control (group II). This study was performed in compliance with the guidelines of Helsinki Declaration. An approval was taken from the local Institutional Review Board and the Research Ethics Committee. Informed consent was taken from each patient before enrollment in the study.

Inclusion criteria were patients of both sexes with psoriasis regardless of severity. Exclusion criteria included patients receiving topical or systemic therapy for psoriasis within the last 3 months; patients on drugs that can affect the adiponectin level such as thiazolidinedione, doxazocin, metoprolol, ramipril, amlodipine, fibrates, or niacin; and patients suffering from diabetes or cardiovascular disease.

All patients included in this study were subjected to full history taking and BMI calculation. General and dermatological examination for all patients and controls were done. Severity of psoriasis was assessed by the psoriasis area and severity index (PASI). Mild=PASI score less than 10, moderate=PASI score: 10–20, and severe=PASI more than 20. The PASI includes assessments of four body areas: head and neck (H), trunk (T), upper limbs (UL), and lower limbs (LL). Within each area the severity of three signs, erythema (E), thickness/induration (I), and desquamation/scaling (D), is assessed on a five-point scale: 0, none; 1, mild; 2, moderate; 3, severe; and 4, very severe [9].

Assessment of serum fatty acid-binding protein 4 and adiponectin level

A measure of 5 ml venous blood was collected and centrifuged within 30 min after being drown. Blood was centrifuged for 15 min at ∼1000g. Serum was collected and stored at –20°C in aliquots until the assay is performed. FABP4 and adiponectin levels were measured using the FABP4 enzyme-linked immunosorbent kit, Biokit for Scientific Research Co., Sun Red Bio, China and human adiponectin (ACRP30) AssayMax enzyme-linked immunosorbent kit from Assaypro LLC Company, USA, respectively. The assay range for FABP4 was 0.1–30 ng/ml with a sensitivity of 0.093 ng/ml and intra-assay and inter-assay coefficients of variation were 10 and 12%, respectively. The minimum detectable dose of adiponectin is ∼0.7 ng/ml. Intra-assay and inter-assay coefficients of variation were 4.3 and 7.2%, respectively.

Statistical analysis

Data was collected and coded and then entered into spreadsheets using Microsoft Excel 2010 for Windows of the Microsoft Office bundle; 2010 of Microsoft Corporation, USA. Data was analyzed using IBM Statistical Package for the Social Sciences software (SPSS), version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Normally distributed continuous data was expressed as mean±SD. Categorical data was displayed as frequency and percentage. Kruskal–Wallis test, χ

2 test, and Spearman test were used.

  Results 

A case–control study including 35 psoriatic patients (group I) and 35 apparently healthy volunteers as a control (group II) with matched age and sex was done in the Dermatology Outpatient Clinics. The psoriasis group included 22 males and 13 females compared with the control group of 19 males and 16 females. There was no statistically significant difference between the psoriasis and control groups regarding sex and age. However, there was a statistically significant difference between the psoriasis and control groups regarding BMI ([Table 1]). Twenty-one (60%) psoriasis patients had early onset, while 14 (40%) psoriasis patients had late onset with the mean of disease duration being 6.3±4.1 years. Only five patients had a family history of psoriasis. The PASI score ranged from 2.4 to 49.7; 48.6% of patients had mild psoriasis, while 14.3% had moderate psoriasis and 37.1% had severe psoriasis.

Table 1 Comparison between the two studied groups according to demographic data

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Serum adiponectin level was higher in the control group than in the psoriasis group with highly statistically significant difference between them; however, serum FABP4 level was lower in psoriasis patients compared with the control group with statistically significant difference between them ([Table 2]). There were no stastistical correlations between adiponectin or FABP4 levels and the duration of disease. Also, serum FABP4 and adiponectin level had no relation with increased psoriasis severity. There was negative significant relation between serum adiponectin level and BMI; however, there was no relation between serum FABP4 level and BMI ([Table 3]).

Table 2 Comparison between the psoriasis and control groups regarding serum fatty acid-binding protein 4 and adiponectin levels

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Table 3 Correlation between BMI and psoriasis area and severity index score and disease duration with fatty acid-binding protein 4 and adiponectin in the case group (N=35)

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  Discussion 

There is some controversy about the serum level of adiponectin, FABP4, and their relation with the severity of psoriasis and BMI in the literature. The definite role of adiponectin and FABP4 is still unknown in the pathogenesis of psoriasis, and the existing clinical information is still not sufficient [10].

In our study, serum adiponectin level was elevated in the control group than in the psoriasis group with highly statistically significant difference between them. This came in agreement with Madanagobalane et al. [11], Zhu et al. [12], and Eder et al. [13], who observed that the mean levels of serum adiponectin were also decreased significantly in patients than in the control group.

The published data on adiponectin levels in psoriasis are still inconsistent in the literature. Most of the research studies including our study show that serum levels of adiponectin was significantly decreased in psoriasis [14],[15],[16],[17]. It is supposed that adiponectin has an anti-inflammatory activity in addition to its role in the regulation of metabolic processes. It was shown that tumor necrosis factor-α and interleukin-6 inhibit the synthesis of adiponectin by the adipose tissue [8],[14]. One of the causes of decreased production of adiponectin by the subcutaneous and visceral adipose tissue is the elevated levels of proinflammatory cytokines in psoriasis, particularly interleukin-6 [8],[14].

In addition, the mean serum FABP4 level in the control group was significantly higher than in patients. This came as against the study by Baran et al. [1], who found that the mean serum FABP4 level in psoriasis patients was higher than that in the control group with statistically significant difference between them. In our study, there were no significant relations between adiponectin or FABP4 levels and disease duration . This came in parallel with other studies [1],[18].

This study demonstrated that serum FABP4 and adiponectin level have no relation with increased psoriasis severity. This came in disagreement with Baran et al. [18], who found that the serum level of adiponectin was significantly correlated with disease severity. Oh et al. [16] observed that the serum level of adiponectin showed no correlation with PASI score. However, this came in agreement with Baran et al. [1], who found that FABP4 did not seem to have a role in determining the severity of psoriasis.

In this study, we detected a negative significant correlation between serum adiponectin level and BMI as its level decreased more in obese patients; however, there was no significant correlation between serum FABP4 level and BMI, which was statistically proved. This came in disagreement with Baran et al. [1], who found that serum FABP4 was elevated in overweight patients more than in controls or normal-weight patients. Therefore, it may be thought that serum levels of FABP4 in psoriatic patients are not only dependent on the expression of adipose tissue by BMI but as well on other effectors affecting various inflammatory and immunological stimuli in psoriasis such as ectopic fat accumulation. In addition, exercises act as an influential factor for increased serum FABP4 level. All the above-mentioned factors may influence FABP4 level, which may interfere with our results.In disagreement with our study, Madanagobalane et al. [11] found that adiponectin levels showed no changes between normal weight and overweight groups. However, this came in parallel with Baran et al. [18] and others [8],[15],[19], who found that adiponectin was negatively correlated with BMI. Thus, the data indicate the need to consider the nutritional state of psoriasis patients when assessing the clinical studies on adipokines. Low adiponectin levels in obese patients may contribute to increased susceptibility of evolution of different chronic diseases with inflammatory process.

  Conclusion 

In this study, serum FABP4 and adiponectin levels were decreased in patients with psoriasis with no relation with disease severity. So, they cannot be used as a clinical biomarker of inflammation and disease activity in psoriasis. Some limitations of this study are the small number of patients and shortage of data from the literature. There is a necessity to further clarification of the main role of FABPs in psoriasis, adiponectin, and their potential to predict or even treat psoriasis. We concluded that low adiponectin levels in obese individuals may contribute to increased susceptibility of evolution of different chronic diseases with inflammatory process.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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  [Table 1], [Table 2], [Table 3]