Effect of Narrow Band Ultraviolet B Therapy versus Methotrexate on Serum Levels of Interleukin-17 and Interleukin-23 in Egyptian Patients with Severe Psoriasis
Background. There is raised interest in the involvement of interleukin-(IL-)23/T-helper 17 cells (Th17) axis in the pathogenesis of psoriasis. Objectives. To compare the effect of narrow band ultraviolet B (NB-UVB) and methotrexate (MTX) therapy on serum levels of IL-17 and IL-23 in psoriatic patients. Methods. Thirty patients with severe plaque psoriasis were included: 15 patients received NB-UVB three times weekly (group I) and 15 patients received MTX 0.3？mg/kg per week (group II), both for 8 weeks. Before and after treatment, serum levels of IL-17 and IL-23 were investigated by ELISA technique and psoriasis area and severity index (PASI) was calculated. Results. After treatment, all patients showed a reduction in their PASI score, IL-17 and IL-23 serum levels with a nonsignificant difference between both therapeutic modalities ( value ). A positive correlation was detected between the percent of reduction of IL-17, IL-23 and the percent of reduction of PASI score for patients receiving both treatments. No correlation was found between the percent of reduction of IL-17, IL-23 and duration of disease or age of all patients in this study. Conclusion. Interleukin-17 and IL-23 serum level may serve as a potential biomarker for predicting the prognosis and therapeutic response of NB-UVB or MTX in treating psoriasis. 1. Introduction Psoriasis is a cutaneous disorder characterized by epidermal hyperproliferation and inflammation with a marked infiltration of T cells, neutrophils, and macrophages. Psoriatic inflammation was once considered to be mediated by T-helper 1 (Th1) cells; however, recent studies increasingly indicate that immune responses by newly characterized Th17 cells are also involved in the pathogenesis of psoriasis [1, 2]. The findings of several reports of elevated levels of interleukin- (IL-) 23 and Th17 related cytokines in cutaneous lesions and in the serum of psoriatic patients, as well as the association of IL-23 receptor gene (IL-23R) variants with psoriasis, provide the basis for a rising interest in the IL-23/Th17 axis in psoriasis [2]. T-helper 17 cells are inflammatory CD4+ T cells that do not produce interferon- (IFN-) γ or interleukin- (IL-) 4; instead, they produce IL-6, IL-17, IL-21, IL-22, and tumor necrosis factor (TNF)-α [3]. Interleukin-17 family, for which the Th17 cells lineage is named, consists of six cytokines (IL-17A-F). IL-17A, IL-17B, IL-17C, and IL17F have proinflammatory properties, can induce cytokines such as TNF and IL-1, and promote neutrophil migration. Interleukin-17 also expresses the IL-23R. Although Th17
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