is psoriasis a bowel disease? - american academy of ... f020... · is psoriasis a bowel disease?...
TRANSCRIPT
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Is psoriasis a bowel disease? HainesElyM.D.
ClinicalProfessorofDermatologyUCDavis
Rxderm-L An Interna8onal Dermatology on line discussion group • Tojoinwritetome:
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Is psoriasis a bowel disease?
• Ifyou’dliketoleaveearly:Theanswerisyes• PsoriasisisasystemicdiseasecausedbytheabsorpJonofbacterialpepJdoglycansandendotoxin(LPS)fromthegut(beginningatthemouth,tonsils)Thereisincreasedgutpermeability.• DysbiosisandovergrowthofanJgenicbacteria(streppyogenes)• BileacidabnormaliJesinliverandbile• AbnormalliverfuncJon,faSyliver,fibrosis,micronodularcirrhosis• Metabolicsyndromeistheresult,psoriasisisacatharJcevent
Pathogenesis of Psoriasis, Ely, 1981
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Treatment
• Alterbowelfloratowardnormal:ProbioJcs,S.boulardii,anJbioJcsAzithromycin,clindamycinhavehadsuccess• Breakupendotoxininbowelwithbileacids• InhibitabsorpJonofendotoxin/pepJdoglycanswithbioflavonoids(myriceJn,querceJn,curcumin,orangejuice)NoETOHorpepper• Inhibitphosphorylkinasewithcurcumin,myriceJn,querceJn• Healliverwithsilymarin(alsophosphodiesteraseinhibitorlikeapremilast)
Today’s concept of psoriasis
• AnimmunologicabnormalityrelatedtooverproducJonofinflammatorycytokinesbyTcells• GeneJcpredisposiJon• ExacerbatedbybacterialsuperanJgens• NomenJonoftheprimaryanJgenwhichiniJatesTcellresponse
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Targe8ng key psoriasis pathways
Current therapy targets only the end result not the cause of psoria8c inflamma8on
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How can we relate the comorbidi8es of psoriasis to the bowel?
AmJClinNutr.Apr2010;91(4):940–949.PublishedonlineMar3,2010
Orangejuiceneutralizestheproinflammatoryeffectofahigh-fat,high-carbohydratemealandpreventsendotoxinincreaseandToll-likereceptorexpression1,2,3HusamGhanim,ChangLingSia,MannishUpadhyay,KellyKorzeniewski,PrabhakarViswanathan,SanaaAbuaysheh,PriyaMohanty,andPareshDandonacorrespondingauthor
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Background:Theintakeofglucoseorahigh-fat,high-carbohydrate(HFHC)meal,butnotorangejuice,inducesanincreaseininflammaJonandoxidaJvestressincirculaJngmononuclearcells(MNCs)ofnormal-weightsubjects.Objec0ve:WeinvesJgatedtheeffectoforangejuiceonHFHCmeal–inducedinflammaJonandoxidaJvestressandtheexpressionofplasmaendotoxinandToll-likereceptors(TLRs).Design:Threegroups(10subjectsineachgroup)ofnormal,healthysubjectswereaskedtodrinkwateror300kcalglucoseororangejuiceincombinaJonwitha900-kcalHFHCmeal.Bloodsampleswereobtainedbeforeand1,3,and5hakerthedrinksandmealcombinaJonswereconsumed.
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Conclusions:ThecombinaJonofglucoseorwaterandtheHFHCmealinducedoxidaJveandinflammatorystressandanincreaseinTLRexpressionandplasmaendotoxinconcentraJons.Incontrast,orangejuiceintakewiththeHFHCmealpreventedmeal-inducedoxidaJveandinflammatorystress,includingtheincreaseinendotoxinandTLRexpression.TheseobservaJonsmayhelpexplainthemechanismsunderlyingpostprandialoxidaJvestressandinflammaJon,pathogenesisofinsulinresistance,andatherosclerosis.
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“Herewereportthat,inmice,relaJvelylowconcentraJonsoftwocommonlyusedemulsifiersnamelycarboxymethylcelluloseandpolysorbate-80,inducedlow-gradeinflammaJonandobesity/metabolicsyndromeinwild-typehostsandproducedrobustcoliJsinmicepredisposedtothisdisorder.”
Chronic systemic inflamma8on and metabolic syndrome are caused by systemic absorp8on of endotoxin from the gut. Atherosclerosis is also caused by deposi8on of bacterial pep8doglycans in the arterial walls. References at the end of presenta8on
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The pep8doglycan of all bacteria is essen8ally the same. Responsible for cell wall rigidity
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The Bowel Bypass Syndrome:
• PepJdoglycananJbodiespresentinalmostallpaJents• PsoriaJcpaJentsusedascontrols• 20%ofpsoriaJcshadhighJtersofpepJdoglycananJbodiesEly,PH,Thebowelbypasssyndrome:aresponsetobacterialpepJdoglycansJAAD1980:2:473-487
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IS PG an Endotoxin?
Similari8es between acute psoriasis and endotoxemia • Fever• Leukocytosis• Increasedcapillarypermeability• ElevatedliverfuncJonenzymes• Decreasedcomplementlevels• AbnormaliJesoflipidmetabolism• Riseoflysosomalenzymes
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Sources of Endotoxin: Teeth Quantification of endotoxins in necrotic root canals from symptomatic and asymptomatic teeth Samples were collected from root canals of 50 patients requiring endodontic treatment due to necrosis of the pulpal tissue. Endotoxin was present in all the samples studied [range 2390.0 to 22100.0 endotoxin units (EU) ml. The mean concentration of endotoxin in samples from patients with spontaneous pain was 18540.0 EU ml while in asymptomatic cases it was 12030.0 EU ml
Source of pep8doglycans: Infected tonsils
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Psoria8cs have increased gut permeability
PsoriaJcpaJentshavemeasuredcirculaJngendotoxinlevelswhichhavebeendemonstratedinnumerousstudiesTheyhaveabnormal51CR-labeledEDTAabsorpJontestresults(excreJngmore51CR-labeledEDTAthancontrols)67-80%ofpsoriaJcshavecirculaJngIGAimmunecomplexes
Cutaneous polyamines in psoriasis
• OrnithinedecarboxylaseacJvityisincreasedinpsoriaJcskin
• Thisenzymebreaksdownputrecine,spermidine,andspermineTheseenzymesareelevatedinpsoriaJcskinandcauseepidermalproliferaJon.UrinarylevelsfallaspsoriaJcplaquesresolveTheycomefrombacteriaintheintesJnallumen
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Recent data confirms the presence of gut derived bacterial DNA in psoria8c blood
OnlineFirstResearchLeSer|March11,2015Iden0fica0onofBacterialDNAinthePeripheralBloodofPa0entsWithAc0vePsoriasisAnaRamírez-Boscá,MD1,2;VicenteNavarro-López,MD2,3;AsunciónMartnez-Andrés,MD1,2;JoséSuch,MD4,5,6;RubénFrancés,PhD4,5;JoséHorgadelaParte,MD7;ManuelAsín-Llorca,MD1JAMADermatol.PublishedonlineMarch11,2015.
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Fiky-fourpaJentswithpsoriasisand27controlswereincludedinthestudy.ThebaselinecharacterisJcsoftheseparJcipantsareshowninTable1.BloodbactDNAwaspresentin16paJentswithpsoriasis,allofwhomshowedthephenotypeofplaquepsoriasis(16of45[35.5%]),whereas6paJentswithguSatepsoriasis,3withinversepsoriasis,andall27controlsdidnothavebactDNAintheblood.SpeciesidenJficaJoncorrespondedtoEscherichiacoli(n=9),Klebsiellapneumoniae(n=2),Enterococcusfaecalis(n=2),Proteusmirabilis(n=1),Streptococuspyogenes(n=1),andShigellafresneli(n=1).
AhigherproporJonoffindingsofbactDNAinthebloodwasobservedinpaJentswithplaquepsoriasiscomparedwithpaJentswithotherpsoriasisphenotypes(35.5%vs0%;P<.05).ThepaJent’sageatdiagnosisofpsoriasisandyearssincethefirstepisodeofpsoriasisshowedstaJsJcallysignificantdifferencesinpaJentswithandwithoutbactDNAintheblood.ThesystemicinflammatoryresponsewassignificantlyhigherinpaJentswithbactDNAcomparedwithotherpaJentsandcontrols
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NucleoJdesequencingrevealedthatEcoliwasthemostprevalentsourceofbactDNA(9of16isolates).Therestofthebacterialspecies’originofthedetectedgenomicfragmentsalsocorrespondedtothetypeoffloracommonlyfoundintheintesJnallumen.Therefore,thebactDNAdetectedinourpaJentswithpsoriasismayhavetheiroriginintheintesJnallumen.
Kidney Interna&onal 2001(59):1580-89 Historical concept of “catharsis” through skin
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Peslyak, M: Model of pathogenesis of psoriasis, online www.psoriasis.info.com • 213psoriaJcsexamined• Diseaseofliverandbileductsdiagnosedin88• Bileof67psoriaJcsfromduodenalintubaJonanalyzed• 1stgroup(28persons)includedpsoriaJcswithhepatobiliarysystemdisorders• 2ndgroup(39persons)psoriaJcswithoutsuchdisorder• Bothgroups(comparedto15controls)hadsignificantreducJonofbileacidlevelsinbile
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Peslyak, M: Model of pathogenesis of psoriasis, online www.psoriasis.info.com • 50psoriaJcsexamined• HighBAlevels(10-20Jmeshigherthanstandard)correlatedwithdiseaseseverityandstability• FreesecondaryDC-BAlevelsindicatedisorderedenterohepaJccirculaJonbecausemainsiteofformaJonismicrofloraofsmallintesJne
Peslyak, M: Model of pathogenesis of psoriasis, online www.psoriasis.info.com • IncreaseofprimaryC-BA,synthesizedbyhepaJccells,isasignofconjugaJondisorderand/ordisorderofpatencyofbileducts• Studiesofbilelithogenicityshowedlevelsofbileacidsandphospholipidsinbileweresignificantlydecreasedandlithogenicindexeswere2-4JmesincreasedinpsoriaJcs.
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The psoria8c intes8nal microbiome: Dysbiosis
The gut is the largest lymphoid organ in the body.
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ScherJU,UbedaC,ArtachoA,ASurM,IsaacS,ReddySM,etal.DecreasedbacterialdiversitycharacterizesthealteredgutmicrobiotainpaJentswithpsoriaJcarthriJs,resemblingdysbiosisininflammatoryboweldisease.ArthriJsRheumatol.2015;67(1):128–39.Epub2014/10/17.
ThegutmicrobiotaofpaJentswithpsoriasiswascharacterizedbyareducedrelaJveabundanceofthegeneraParabacteroidesandCoprobacillusComparisonbetweenthePsAandpsoriasisgroupsrevealedthatthehighertaxonomiclevelsofAkkermansiaandRuminococcus(includingFirmicutes/ClostridialesandVerrucomicrobiales,respecJvely)weresignificantlylessabundantinPsApaJentswhereastheBacteroidetesphylumandCoprobacillusgenuswerelessabundantinpsoriasispaJents.
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Conclusion
PaJentswithPsAandpaJentswithskinpsoriasishadalowerrelaJveabundanceofmulJpleintesJnalbacteria.AlthoughsomegenerawereconcomitantlydecreasedinbothcondiJons,PsAsampleshadalowerabundanceofreportedlybeneficialtaxa.ThisgutmicrobiotaprofileinPsAwassimilartothatpreviouslydescribedinpaJentswithinflammatoryboweldiseaseandwasassociatedwithchangesinspecificinflammatoryproteinsuniquetothisgroup,anddisJnctfromthatinpaJentswithskinpsoriasisandhealthycontrols.Thus,theroleofthegutmicrobiomeintheconJnuumofpsoriasis–PsApathogenesisandtheassociatedimmuneresponsemeritsfurtherstudy.
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2009-2012. Peslyak MY, Model of pathogenesis of psoriasis. Part 1
• 75%ofpsoriaJcswithmoderatediseaseand97%withseverediseasehad“maximumdisturbancesofcolonicmicroflora”andthechangesincreasedwithduraJonofdisease
2009-2012. Peslyak MY, Model of pathogenesis of psoriasis. Part 1 (Colon bacteria found in small intes8ne)
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2009-2012. Peslyak MY, Model of pathogenesis of psoriasis. Part 1 Blastocystosis present in 79% of psoria8cs
Blastocystosis (Blastocys8s hominis) • Afewofmostcommonlyreportedsymptomsare:• abdominalpain[15]• itching,usuallyanalitching[15]• consJpaJon[15]• diarrhea[15]• wateryorloosestools[15]• weightloss[15]• faJgue• flatulence[15]• Somelesscommonlyreportedsymptomsinclude:• SkinRash[16][17][18][19][20][21]• Headache,[9][17]depression[9]• ArthriJcsymptomsandjointpain[22][23]• IntesJnalinflammaJon[24
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Treatment
• Alterbowelfloratowardnormal:ProbioJcs,S.boulardii,anJbioJcsSulfasalazine,Azithromycin,clindamycinhavehadsuccess• Breakupendotoxininbowelwithbileacids• InhibitabsorpJonofendotoxin/pepJdoglycanswithbioflavonoids(myriceJn,querceJn,curcumin,orangejuice)NoETOHorpepper• Inhibitphosphorylkinasewithcurcumin,myriceJn,querceJn• Healliverwithsilymarin(alsophosphodiesteraseinhibitorlikeapremilast)
Treatment of BLE + psoria8cs
• MiconazoleandquinacrinehavebeenreportedaseffecJveagentsagainstBlastocysJsgrowthin-vitro.[79][86]Rifaximin,[87]andalbendazolehaveshownpromiseashasivermecJnwhichdemonstratedhigheffecJvenessagainstblastocysJshominisisolatesinaninvitrostudy.[88]ThereisalsoevidencethattheprobioJcyeastSaccharomycesboulardii,[82]andtheplantmallotusopposiJfolius[89]maybeeffecJveagainstBlastocysJsinfecJons
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Treatment
• Alterbowelfloratowardnormal:ProbioJcs,S.boulardii,anJbioJcsSulfasalazine,Azithromycin,clindamycinhavehadsuccess• Breakupendotoxininbowelwithbileacids• InhibitabsorpJonofendotoxin/pepJdoglycanswithbioflavonoids(myriceJn,querceJn,curcumin,orangejuice)NoETOHorpepper• Inhibitphosphorylkinasewithcurcumin,myriceJn,querceJn• Healliverwithsilymarin(alsophosphodiesteraseinhibitorlikeapremilast)
SulfasalazineImprovesPsoriasisADouble-blindAnalysisAdityaK.Gupta,MD,FRCPC;CharlesN.Ellis,MD;MichaelT.Siegel,MD;ElizabethA.Duell,PhD;ChristopherE.M.Griffiths,BSc,MB,MRCP;TedA.Hamilton,MS;BrianJ.Nickoloff,MD,PhD;JohnJ.Voorhees,MDArchDermatol.1990;126(4):487-493.
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Inan8-weekdouble-blindtrialofsulfasalazineforthetreatmentofmoderate-to-severepsoriasis,23and27paJentsreceivedtheacJveandplacebotablets,respecJvely.Attheendofthedouble-blindphase,therewere17assessablepaJentsreceivingsulfasalazine;7(41%)hadmarkedimprovement,7(41%)hadmoderateimprovement,and3(18%)demonstratedminimalchange.Only1paJentreceivingplacebodemonstratedmoderateimprovement,whereastheresthadminimalimprovementorworseningofpsoriasis.WhentherandomizaJoncodewasbroken,paJentsreceivingsulfasalazinewereallowedtoconJnuetherapyforanaddiJonal4weeksinanopenmanner,whilethoseusingplacebolekthestudy.Sixof23paJentsdisconJnuedsulfasalazinetherapyduringthedouble-blindphasebecauseofsideeffects,4duetothedevelopmentofacutaneouserupJonand2duetonausea.Fourteenof17paJents,whowereassessableattheendofthe8-weekdouble-blindphase,completedtheaddiJonal4weeksofsulfasalazinetherapy.Ofthese14paJents,markedimprovementoccurredin8(57%),moderateimprovementin2(14%),andminimalimprovementin4(29%),comparedwithpretherapy.ThelowincidenceofseveresideeffectsmakessulfasalazineaconsideraJonfororaltherapyinpaJentswhosediseaseseveritydoesnotjusJfyuseofmethotrexate,etreJnate,orpsoralenplusUV-A,butwhosediseaseseverityistoowidespreadforsafeandpracJcaluseoftopicalcorJcosteroids.(ArchDermatol.1990;126:487-493)
Sulfasalazine
• AzoreducJvecleavagebycolonbacteriaresultsinformaJonof5-aminosalicylicacidandsulfapyridine• InhibitsnuclearfactorKappaB• (NF-kB)isatranscripJonfactorthatgovernstheexpressionofgenesencodinginflammatorycytokines
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SSZ inhibits TNF-a binding
• Immunopharmacology.1990Nov-Dec;20(3):217-24.• SulfasalazineinhibitsthebindingofTNFalphatoitsreceptor.ShanahanF,NiederlehnerA,CarramanzanaN,AntonP.
Treatment
• Alterbowelfloratowardnormal:ProbioJcs,S.boulardii,anJbioJcsSulfasalazine,Azithromycin,Clindamycinhavehadsuccess• Breakupendotoxininbowelwithbileacids• InhibitabsorpJonofendotoxin/pepJdoglycanswithbioflavonoids(myriceJn,querceJn,curcumin,orangejuice)NoETOHorpepper• Inhibitphosphorylkinasewithcurcumin,myriceJn,querceJn• Healliverwithsilymarin(alsophosphodiesteraseinhibitorlikeapremilast)
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Annals Immunologiae Hungaricae XVII
Bile Detoxifica8on of LPS
• Commonbileductofratscannulated• BiledeprivedratsdiewhengivenLPSorally• RadiolabeledLPSisfoundintheirblood• IntesJnalabsorpJonofLPSinbiledeprivedratscanbepreventedbysodiumdeoxycholate
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Pathophysiology, 2003;10(1):57-61
• Bileacidssplitentericendotoxinsintonontoxicfragments.Bileacidsarealsobactericidal• 800psoriasisptsinstudy,500Rxedwithdehydrocholicacid1-8weeks• 434pts(78.8%)becameasymptomaJc
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Pathophysiology 10 (2003) 57-61
Why no pepper?
• Bothpepperandalcoholwillruinad-xyloseabsorpJontest.• Ifd-xyloseisgivenbymouththeamountfoundinurineindicatesintesJnalpermeability.VeryliSlegetsintourine.IfalcoholorpepperisgivenatthesameJmeahugeamountofd-xyloseendsupinurine.
• Amoremodernversionisthe(Cr51)EDTAexcreJontestpreviouslymenJoned
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Pathophysiology, 2003;10(1):57-61
• Of249ptswhoreceivedconvenJonaltherapyonly62(24.9%)showedclinicalrecoveryoverthesameJmeframe• BileacidRxofacutepsoriasis95.1%completerecovery• Twoyearslater319of551ptsRxedwithbileacids(57.9%)wereasymptomaJc
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DehydrocholicacidHungarianpaper
DeoxycholicacidFromcholicacidingut
UrsodeoxycholicacidJapanesepaper
Bile Acid Rx of Psoriasis
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Treatment
• Alterbowelfloratowardnormal:ProbioJcs,S.boulardii,anJbioJcsAzithromycin,clindamycinhavehadsuccess• Breakupendotoxininbowelwithbileacids• InhibitabsorpJonofendotoxin/pepJdoglycanswithbioflavonoids(myriceJn,querceJn,curcumin,orangejuice)NoETOHorpepper• Inhibitphosphorylkinasewithcurcumin,myriceJn,querceJn• Healliverwithsilymarin(alsophosphodiesteraseinhibitorlikeapremilast)
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JNutrBiochem.2011Jan;22(1):53-9.Epub2010Mar20.Emulsifiedlipidsincreaseendotoxemia:possibleroleinearlypostprandiallow-gradeinflamma0on.LaugereSeF1,VorsC,GéloënA,ChauvinMA,SoulageC,Lambert-PorcheronS,Pere|N,AlligierM,BurcelinR,LavilleM,VidalH,MichalskiMC.
AbstractLow-gradeinflammaJonisariskfactorfortheonsetofatherosclerosis.LiSleisknownabouttheinvolvementofendotoxinabsorpJonfromthegutduringthedigesJonoflipids.Inthepresentstudy,wefirstinvesJgatedinhumanstheimpactofamixedmealcontainingdispersedlipidsonpostprandialendotoxemiaandinflammaJon.WetheninvesJgatedtheeffectof(i)oilemulsificaJoninvivoinratsand(ii)faSyacidamountsinvitrousingCaco-2cellsonpostprandialendotoxemia.Inhumans,postprandialendotoxemiaincreasedearlyakerthemeal.Moreover,weevidencedthattheendotoxinreceptorsCD14increasedduringdigesJonandthatchylomicronscouldcontributetoabsorbedendotoxintransport.ThiscouldexplainthesignificantpeakofinflammatorycytokineIL-6thatweobserved2hakerthemixedmeal.InteresJngly,inrats,theemulsionledtobothhigherendotoxemiaandhypertriglyceridemiathanoilandcomparedtoacontrolsalineload.Invitro,incubaJonofCaco-2cellswithincreasingfaSyacidconcentraJonsenhancedepithelialabsorpJonofendotoxin.Toourknowledge,thisisthefirststudyevidencinginhealthyhumansthat,followingamixedmealcontaininglipids,increasedendotoxemiaisassociatedwithraisedsCD14andapeakofIL-6.Onarepeatedbasis,thismaythusbeatriggeringcascadefortheonsetofatherosclerosis.Inthisrespect,opJmizingbothdietaryfatamountandstructurecouldbeapossiblestrategytolimitsuchlow-gradeendotoxemiaandinflammaJonbythecontrolofpostprandiallipemia
PlantFoodsHumNutr.2013Mar;68(1):1-10..
An0-inflammatoryproper0esoforangejuice:possiblefavorablemolecularandmetaboliceffects.CoelhoRC1,HermsdorffHH,BressanJ.Authorinforma0on
AbstractThelow-gradeinflammaJonhasbeenrecognizedasthelinkbetweenadiposityandtheriskofchronicmetabolicdisorders.Thus,increasedconcentraJonsofinflammatorymarkers,suchasinterleukinsandtumornecrosisfactoralphahavebeenfoundinobeseindividuals.Inturn,dietcanposiJvelyornegaJvelyinfluenceontheriskofchronicmetabolicdiseasesbymodulaJngtheinflammatorystatus.Inthiscontext,orangejuiceconsumpJoncanplayaroleinmodulaJonofinflammatorymarkersthroughbioacJvecompounds,suchastheflavonoids(hesperidin,naringenin).Accordingtothisreview,orangejuiceappearstomediatetheinflammatoryresponseinplasmalevelandgeneexpression,andinpostprandialandchronic(≥7consecuJvedays)periods.ThecurrentfindingssuggestthatorangejuicecouldbeadietaryfeatureforprevenJonandtreatmentofchronicdiseases,
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Flavonoids
QUERCITIN
• “Backbone”forotherflavonoidsie:• RuJn• Hesperidin• Naringin• TangeriJn
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Querci8n
• PotentanJoxidant• Inhibitsmanufactureandreleaseofhistamine• AnJinflammatory• Inhibitscollagenase,preventscollagenbreakdown
Querci8n prevents Metabolic syndrome
• PfeufferM,AuingerA,BleyU,etal.,EffectofquerceJnontraitsofthemetabolicsyndrome,endothelialfuncJonandinflammaJoninmenwithdifferentAPOEisoforms.NutrMetabolCardiovascDis.2013;23(5):403-9
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Querci8n prevents metabolic syndrome
• EgertS,Bosy-WestphalA,SeiberlJ.,etalQuerciJnreducessystemicbloodpressureandplasmaoxidizedlowdensitylipoproteinconcentraJonsinoverweightsubjectswithahigh-cardiovasculardiseaseriskphenotype:Adoubleblindedplacebo-controlledcross-overstudy.BrJNutr.2009;102(7):1065-74
Treatment
• Alterbowelfloratowardnormal:ProbioJcs,S.boulardii,anJbioJcsAzithromycin,clindamycinhavehadsuccess• Breakupendotoxininbowelwithbileacids• InhibitabsorpJonofendotoxin/pepJdoglycanswithbioflavonoids(myriceJn,querceJn,curcumin,orangejuice)NoETOHorpepper• Someofthesebioflavonoidsarealsophosphodiesteraseinhibitors• Inhibitphosphorylkinasewithcurcumin,myriceJn,querceJn• Healliverwithsilymarin(alsophosphodiesteraseinhibitorlikeapremilast)
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InvestNewDrugs.2008Oct;26(5):417-24.doi:10.1007/s10637-008-9114-7.Epub2008Feb9.
Inhibitoryeffectsofquerce0nderiva0vesonphosphodiesteraseisozymesandhigh-affinity[(3)H]-roliprambindinginguineapig0ssues.
ChanAL1,HuangHL,ChienHC,ChenCM,LinCN,KoWC.
Authorinforma0on
Abstract
Rolipramhashigh(PDE4(H))andlow(PDE4(L))affiniJesforphosphodiesterase(PDE)-4,respecJvely.Ingeneral,itisbelievedthatinhibiJonsbyPDE4(H)andPDE4(L)arerespecJvelyassociatedwithanadverseresponseandwithanJ-inflammatoryandbronchodilaJngeffects.ThishasprovidedaraJonalbasisfordesigningnewcompoundswithhighPDE4(H)/PDE4(L)raJos.Inthepresentstudy,weaSemptedtodeterminethePDE4(H)/PDE4(L)raJosofquerceJn(1),TheacJviJesofPDE1approximately5,whichwereparJallyseparatedfromhomogenatesofguineapiglungsandhearts,weremeasuredbyatwo-stepprocedureusingadenosine3',5'-cyclicmonophosphate(cAMP)with[(3)H]-cAMPorguanosine3',5'-cyclicmonophosphate(cGMP)with[(3)H]-cGMPassubstrates..TheanJ-inflammatoryeffectsofPDE4inhibitorswerereportedtobeassociatedwithinhibiJonofPDE4catalyJcacJvity.Therefore,theseIC(50)valuesforPDE4inhibiJonweretakenasthePDE4(L)values.TheeffecJveconcentraJon(EC(50)),atwhichonehalfofthe[(3)H]-rolipramboundtohigh-affinityroliprambindingsites(HARBSs)ofbraincellmembraneswasreplaced,wasdefinedasthePDE4(H)value.Inthepresentresults,thePDE4(H)/PDE4(L)raJosofquerceJn(1),ayanin(3),andQPME(5)were>30,>19,and11,respecJvely(Table1),whicharehigherthanorequaltothatofAWD12-281,theselecJvePDE4inhibitorwiththegreatestpotenJalcurrentlyundergoingclinicaltrialsfortreaJngasthmaandchronicobstrucJvepulmonarydisease.
BiochemPharmacol.2004Nov15;68(10):2087-94.Inhibitoryeffectsofflavonoidsonphosphodiesteraseisozymesfromguineapigandtheirstructure-ac0vityrela0onships.KoWC1,ShihCM,LaiYH,ChenJH,HuangHL.Authorinforma0onAbstractThestructure-acJvityrelaJonshipsofflavonoidswithregardtotheirinhibitoryeffectsonphosphodiesterase(PDE)isozymesareliSleknown.TheacJviJesofPDE1-5weremeasuredbyatwo-stepprocedureusingcAMPwith[(3)H]-cAMPorcGMPwith[(3)H]-cGMPassubstrates.Inthepresentresults,PDE1,5,2,and4isozymeswereparJallypurifiedfromguineapiglungsinthatorder,andPDE3wasfromtheheart.TheIC(50)valuesofPDE1-5weregreaterthanthosereportedpreviouslyforthereferencedrugs,vinpoceJn,EHNA,milrinone,Ro20-1724,andzaprinast,by5-,5-,7-,5-,and3-fold,respecJvely.AsshowninTable2,luteolinrevealednon-selecJveinhibiJonofPDE1-5withIC(50)valuesinarangeof10-20microM,asdidgenisteinexceptwithalowpotencyonPDE5.Daidzein,aninacJveanalogueofgenisteinintyrosinekinaseinhibiJon,showedselecJveinhibiJonofPDE3withanIC(50)valueofaround30microM,asdideriodictyolwithanIC(50)valueofaround50microM.HespereJnandpruneJnexhibitedmore-selecJveinhibiJonofPDE4withIC(50)valuesofaround30and60microM,respecJvely.Luteolin-7-glucosideexhibiteddualinhibiJonofPDE2/PDE4withanIC(50)valueofaround40microM.DiosmeJnmore-selecJvelyinhibitedPDE2(IC(50)of4.8microM)thanPDE1,PDE4,orPDE5.However,biochaninAmore-selecJvelyinhibitedPDE4(IC(50)of8.5microM)thanPDE1orPDE2.ApigenininhibitedPDE1-3withIC(50)valuesofaround10-25microM.MyriceJninhibitedPDE1-4withIC(50)valuesofaround10-40microM.ThesamewastrueforquerceJn,butweratherconsiderthatitmore-selecJvelyinhibitedPDE3andPDE4(IC(50)of<10microM).Inconclusion,itispossibletosynthesizeusefuldrugsthroughelucidaJngthestructure-acJvityrelaJonshipsofflavonoidswithrespecttoinhibiJonofPDEisozymesatconcentraJonsusedinthisinvitrostudy.
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1054SpecialiaExperienJa34/8FlavonoidcompoundsarepotentinhibitorsofcyclicAMPphosphodiesteraseA.Beretz,R.AntonandJ.C.StocletFacult~dePharmacie,Universit~LouisPasteur,LaboratoiredePharmacognosie,andLaboratoiredePharmacodynamie(CNRS,ERA787)F-67083Strasbourg(France),29December1977Summary.TheinhibitoryacJvityof19flavonoidmoleculesoncyclicAMPbreakdownbyacommercial,~beefheartphosphodiesterasepreparaJonisreported.7compoundsareacJveinthemicromolarrange,2ofwhichhaveapotencyequivalenttothatofpapaverine.SomestructureacJvityrelaJonshipsaredrawn
Commercially available
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Treatment
• Alterbowelfloratowardnormal:ProbioJcs,S.boulardii,anJbioJcsAzithromycin,clindamycinhavehadsuccess• Breakupendotoxininbowelwithbileacids• InhibitabsorpJonofendotoxin/pepJdoglycanswithbioflavonoids(myriceJn,querceJn,curcumin,orangejuice)NoETOHorpepper• Inhibitphosphorylkinasewithcurcumin,myriceJn,querceJn• Healliverwithsilymarin(alsophosphodiesteraseinhibitorlikeapremilast)
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MethodsFindExpClinPharmacol.1985Aug;7(8):409-13.Silymarin:potentinhibitorofcyclicAMPphosphodiesterase.KochHP,BachnerJ,LöfflerE.AbstractSilymarin,theacJveprincipleoftheMilkThistle(SilybummarianumGaertner),isaverypotentinhibitorofcyclicAMPbreakdowninvitrobyacommercialbeefheartphosphodiesterasepreparaJon.ItsmainconsJtuents,silybin,silydianinandsilychrisJn,are12.66to52.06JmesmoreacJvethantheophyllineand0.77to3.17JmesmoreacJvethanpapaverineinthisrespect.UsinganovelHPLCtechnique,theenzymekineJcalanalysiscanbeperformedmuchfasterthanbytheclassicalmethods.
Silymarin is a potent phosphodiesterase inhibitor: 50 8mes more potent than theophyline
United States Patent: 5,196,448 March 23, 1993 (Antiinflammatory compositions and method of use: esters of silybin with dicarboxylic acids)
Ely, H., Therapies You’ve Probably Never Heard Of, Dermatologic Clinics, 1989: 7(1): 19-35.
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NFI but I have found this one to work the best in PCT compared to many brands
Hepatology 1997:26(3):643-49
SilymarinRetardsCollagenAccumulaJoninEarlyandAdvancedBiliaryFibrosisSecondarytoCompleteBileDuctObliteraJoninRatsGABRIELEBOIGK,1LUTZSTROEDTER,2HERMANNHERBST,3JU¨RGENWALDSCHMIDT,2ERNSTOTTORIECKEN,1ANDDETLEFSCHUPPAN1
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Trea8ng psoriasis star8ng in the gut
• S.BoulardiionecapTIDforonemonthtostart• Sulfasalazine500mgTID• Bileacids(Oxbile)onecapTIDastolerated• Bioflavinoids(myreciJn,querceJn,orangejuice)witheachmeal• Decreaseinflammatoryfoodssuchasgluten• Avoidspicyfoodsandalcohol• Helptheliverwithsilymarin140mgBID• CurcuminoralandtopicalrecommendedbyMadelineHengM.D.
Pathogenesis of Psoriasis 2016 no change!
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The following references were lem out of talk for sake of 8me
20% or more of Psoria8cs Have Circula8ng Bacterial Pep8doglycan An8bodies
• Ely,P.H.,ImmunopathologyoftheBowelBypassSyndrome,inImmunodermatology,D.M.MacDonald,ed.,BuSerworthandCo.,London,1984.287-89.
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Leners to editor: Arch Dermatol vol 118 March 1982, 143 Endotoxemia in Psoriasis • PatriciaW.Belew,PhD• E.WilliamRosenberg,MD• RobertB.Skinner,Jr,MD• WayneM.Marley,MD• Memphis
Leners to editor: Arch Dermatol vol 118 March 1982, 143 Endotoxemia in Psoriasis EndotoxemiainPsoriasisTotheEditor:WehavebeenabletodetectcirculaJngendotoxininsixof11paJentswithpsoriasis.OurinterestinthepossibilityofendotoxemiainpsoriasisfollowedrecentdemonstraJonsofalteraJonsinlevelsofalternaJvecomplementpathwaycomponentsandofcirculaJngIgAimmunecomplexesinpsoriasis.EndotoxinandimmuneIgAcomplexeseachacJvatethealternaJvecomplementpathway.
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Circula8ng IGA Immune complexes in psoriasis • InthenextthreearJcles67to80%ofpsoriaJcshadcirculaJngIGAimmunecomplexes• IGAissecretedinthegut,shouldnotbehighintheserum
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ScherJU,UbedaC,ArtachoA,ASurM,IsaacS,ReddySM,etal.DecreasedbacterialdiversitycharacterizesthealteredgutmicrobiotainpaJentswithpsoriaJcarthriJs,resemblingdysbiosisininflammatoryboweldisease.ArthriJsRheumatol.2015;67(1):128–39.Epub2014/10/17.
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Figure5.
CorrelaJonsbetweengutmicrobiotaandmetadata.TherelaJveabundanceofgutmicrobiotawasassessedforcorrelaJonswiththelevelsofvariousproteinsandfaSyacids(FAs)intheserumand/orfecalsamplesfrompaJentswithpsoriaJcarthriJs,paJentswithpsoriasis,andhealthycontrols.HeatmapsshowthecorrelaJonsbetweenpaJentmetadataandintesJnalmicrobiotaatthegenuslevel(A)oroperaJonaltaxonomicunit(OTU)level(B).CirclesizesandcolorintensityrepresentthemagnitudeofcorrelaJon.Bluecircles=posiJvecorrelaJons;redcircles=negaJvecorrelaJons.sIgA=secretoryIgA;OPG=osteoprotegerin;CFAs=short-andmedium-chainFAs.
DDeeccrreeaasseedd BBaacctteerriiaall DDiivveerrssiittyy CChhaarraacctteerriizzeess tthhee AAlltteerreedd GGuutt MMiiccrroobbiioottaa iinn PPaa88eennttss WWiitthh PPssoorriiaa88cc AArrtthhrrii88ss,, RReesseemmbblliinngg DDyyssbbiioossiiss iinn IInnflflaammmmaattoorryy BBoowweell DDiisseeaassee
Arthri0s&RheumatologyVolume67,Issue1,pages128-139,27DEC2014DOI:10.1002/art.38892hSp://onlinelibrary.wiley.com/doi/10.1002/art.38892/full#art38892-fig-0005
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DDeeccrreeaasseedd BBaacctteerriiaall DDiivveerrssiittyy CChhaarraacctteerriizzeess tthhee AAlltteerreedd GGuutt MMiiccrroobbiioottaa iinn PPaa88eennttss WWiitthh PPssoorriiaa88cc AArrtthhrrii88ss,, RReesseemmbblliinngg DDyyssbbiioossiiss iinn IInnflflaammmmaattoorryy BBoowweell DDiisseeaassee
Arthri0s&RheumatologyVolume67,Issue1,pages128-139,27DEC2014DOI:10.1002/art.38892hSp://onlinelibrary.wiley.com/doi/10.1002/art.38892/full#art38892-fig-0004
2009-2012. Peslyak MY, Model of pathogenesis of psoriasis. Part 1
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2009-2012. Peslyak MY, Model of pathogenesis of psoriasis. Part 1 (Colon bacteria found in small intes8ne)