Current and potential immune therapies and vaccines in the management of psoriasis

Abstract

Psoriasis is a chronic, immune skin disease associated with significant morbidity. Development of psoriasis is influenced by numerous genes, one allele is HLA-CW*0602. Other genes and single nucleotide polymorphisms affect immunologic pathways and antimicrobial peptide synthesis. Dendritic cells initiate psoriasis by activating T-cells toward a Th1 and Th17 response, with increased cytokines including TNF-α, IL-6, -12, -17, -22, and -23. IL-22 appears to promote keratinocyte dedifferentiation and increased antimicrobial peptide synthesis while TNF-α and IL-17 induce leukocyte localization within the psoriatic plaque. These recent insights identifying key cytokine pathways have led to the development of inhibitors with significant efficacy in the treatment of psoriasis. While a strategy for vaccine modulation of the immune response in psoriasis is in progress, with new technology they may provide a cost-effective long-term treatment that may induce tolerance or targeted self-inhibition for patients with autoimmune disorders, such as psoriasis.

TYK2/JAK1 Inhibitor PF-06700841 in Patients with Plaque Psoriasis: Phase IIa, Randomized, Double-Blind, Placebo-Controlled Trial

“…Mild psoriasis is often treated with topical corticosteroids and vitamin D analogs (Papp et al, 2011). However, around 18e25% of patients with psoriasis have moderate-to-severe disease (Helmick et al, 2014;National Psoriasis Foundation, 2019b), and these patients often require further treatment including phototherapy and systemic treatment with immunosuppressive medications (Kaffenberger et al, 2014;Mrowietz et al, 2011;Papp et al, 2011;Papp et al, 2016a).…”

A Review of Possible Triggering or Therapeutic Effects of Antimicrobial Vaccines on Psoriasis

“…The progression in the enlightenment of the immunopathogenesis of psoriasis may provide new therapeutic options that do not have immunosuppressive side effects. Vaccination is a progressing therapy option for psoriasis and the other chronic inflammatory disorders such as multiple sclerosis, rheumatoid arthritis and atherosclerosis, which are termed as noncommunicable diseases [1,45,46]. It has clearly demonstrated that vaccines have the ability to activate effectors such as dendritic cells and T lymphocytes, which are also involved in psoriasis pathogenesis [41].…”

“…Vaccines are recommended for psoriasis patients due to their susceptibility to infections [12]. The data emphasize that especially some types of vaccines may trigger an exacerbation of psoriatic skin lesions or induce improvement in psoriasis [1,13].…”

“…The stimulation of pDCs is followed by differentiation and activation of myeloid DCs, which express cytokines IL-12, tumor necrosis factor (TNF)-alpha, TGF-beta and IL-6. These cytokines induce T-cells to polarize into Th1 and Th17 subtypes, with suppressing of regulatory T-cells [1,2,6,7]. CD4+ T-cells secreting IL-17 are classified as a different T-helper population called Th17 cells, which are critical in psoriasis pathogenesis.…”

“…Psoriatic arthritis affects approximately 11% of psoriasis patients, and cardiovascular disease is increased [1]. Psoriasis disease is caused by the interactions of genetic background with various environmental triggering factors.…”