الفهرس 
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Abstract
Psoriasis is a chronic and debilitating inflammatory disease with cycles of remissions and exacerbations. It characterized by infiltration of inflammatory cells into the epidermis and altered keratinocyte differentiation. It affects 1-3% of the world population, causing a significant impact on a patient’s quality of life. Psoriasis affects both sexes equally and can appear at any age. Clinical manifestations of psoriasis are heterogeneous, ranging from limited to extensive disease. Many varieties of clinical presentation can occur; plaque, pustular, guttate and erythrodermic. chronic plaque-type psoriasis is the most common variety of psoriasis, representing about 70% to 80% of psoriatic patients. It’s the classical pattern of psoriasis characterized by red, sharply demarcated, erythematous plaques with loosely adherent silvery-white scales, which preferentially affects the elbows, knees and scalp. The disease is variable in extent, duration and periodicity of flare. The aetiology of psoriasis is unknown, but evolving evidence suggests that it is complex disorders caused by interaction of multiple factors including immunological, environmental and genetic factors. It is also believed to be associated with other cellular, biochemical and metabolic defects. Genetic predisposition plays an important role in the pathogenesis of psoriasis and this is supported by several studies that show increased incidence of psoriasis among relatives of Summary 83 affected patients and high rates of concordance for psoriasis among monozygotic twins when one is affected. Apolipoproteins were reportedly elevated in the serum of psoriatic patients. Apo E is implicated in psoriasis by providing protection against some infections, as well as by modulating mitogen-activated T lymphocyte proliferation surrounding CD83+ mature dermis dendritic cells, eventually producing chemokines that activate T lymphocytes. Apo E gene is located on the chromosomal locus 19q13.2 and polymorphism at the Apo E locus results in three common alleles, designated as e2, e3, e4, corresponding to three isoforms (E2, E3, E4, respectively) of the Apo E protein, that can be isolated by isoelectric focusing. The association between Apo E-e2/e3/e4 and psoriasis has been reported by some authors, but others did not confirm this association. The aim of this work was to investigate the relationship between Apo E gene polymorphism and psoriasis and if it has a relation with the severity of the disease. This prospective case control study was carried out on 40 patients, ranged from 25 to 70 years, presented with psoriasis vulgaris, guttate psoriasis and localized pustular psoriasis. They were selected from Dermatology outpatient clinic, Menoufiya University Hospital spanning the period from March 2011 to March 2014. Fifteen age and gender matched healthy volunteers were also included in this study as a control group. All studied cases were subjected to complete history taking, clinical and dermatological examination including assessment of PASI score. Summary 84 Blood samples were taken from patients and control group as well. 5-10 ml of venous blood was withdrawn from the cubital vein of every subject (after fasting for 12 hours) to investigate: 1. Lipid profile: measurement of serum cholesterol, serum TGs, serum LDL and serum HDL. 2. Genotyping: for Apo E gene by PCR and restriction enzymes, (RFLP method). The current study revealed that, there was no significant association between disease severity and each of age and gender of the studied cases. Also, there was no significant association between lipid profile of the patients and severity of the disease. In the present work, there was no significant correlation between PASI score and age, duration of disease and lipid profile of studied cases. The present study also demonstrated a highly significant difference between both psoriatic patients and control with regard to total cholesterol, TGs, LDL and HDL levels. Higher levels of total cholesterol, TGs and LDL and lower levels of HDL were significantly associated with cases. Apo E e3 allele was more prevalent among control than patient group. e2 allele was significantly associated with patient group. e2 allele and e4 allele increase the risk of occurrence of psoriasis. E3/E3 genotype was more prevalent among control group than psoriatic patients. E2/ E3 & E2/ E4 genotypes were significantly associated with psoriatic patients. E2/E3 and E2/E4 genotypes increase the risk of occurrence of psoriasis. E4/E4 Summary 85 was completely absent in control group and present in 5% of cases. It increases the risk of PS. Our results also revealed that, there was no significant association between Apo E genotypes and severity of the disease in studied cases. There was no significant association between different Apo E genotypes and age of cases, duration of disease, gender, types of psoriasis, site involved, family history or onset of disease. The present study also demonstrated a significant association between serum cholesterol, TGs and LDL and Apo E genotypes. Cholesterol and LDL were significantly higher in E4/E4 while TGs showed significant elevation in E2/E4. Also there was a significant association between serum cholesterol, TGs and LDL and Apo E alleles. Cholesterol and LDL were significantly higher in e4 while TGs showed significant elevation in e2. In conclosion, Apo E genotypes E2\E3, E2\E4 and E4\E4 are at risk of developing psoriasis. Apo E e2 and e4 may play a role in psoriasis pathogenesis. Also Apo E e2 and e4 carriers are at risk of dyslipidemia and are prone to atherosclerosis and coronary vascular disease. Apo E genotypes and alleles are not associated with psoriasis severity, clinical type or disease onset. We recommended further studies on larger scales to validate and expand the current findings in Egyptian patients, study the possible role of different apolipoprotiens gene polymorphism in psoriasis and to Study the role of Apo E gene polymorphism in other clinical types of psoriasis (erythrodermic and arthropathic).Screening of psoriatic cases who are carriers of e2 and e4 alleles to early interfere with cardiovascular risk factors. Finally clinical trials are needed to evaluate the value of Apo E protein and gene as a therapeutic target in psoriasis.