**10. Conclusion**

116 Psoriasis

healthy individuals, and the risk of CVD in patients with either diabetes or MetS is

TNF-alpha is an inflammatory cytokine promoting inflammation via the activation and induction of proinflammatory cytokines (IL-1, IL-6, IL-8) and by the upregulation of adhesion molecules on endothelial cells leading to increased leukocyte extravasation

Given that TNF-a show a pivotal role in many inflammatory conditions and that it represents one of possible link between psoriasis and metabolic syndrome, theoretically the TNF-alpha blockade might have a widespread potential in the treatment of both

Although it is well known the TNF-alpha inhibitors efficacy on PsO and Psoriatic arthritis

Currently, three available in the United States are approved for psoriasis and psoriatic

Infliximab is a chimeric monoclonal antibody binding the human tumor necrosis factor

Actually there are no data in literature about infliximab effect on insulin resistance or

About lipid profiles, studies have shown that infliximab does not significantly modify total cholesterol, triglycerides and, interestingly, the patient's lipid profile reverted to baseline values after infliximab discontinuation (Gisondi P et al, 2008; Antoniou KM et al, 2008).

Studies investigating the effect of infliximab on body weight have reported significant increase in weight gain and in BMI, without differences among males and females

Etanercept is a fusion protein consisting of two molecules of extracellular domain of human p75 TNF-alpha receptor attached to the Fc domain of human immunoglobulin G1 (IgG1), that binds to TNF-alpha with greater affinity than natural receptor. The binding makes TNFalpha biologically inactive, with consequent reduction of inflammation (Weinberg JM,

Although there are conflicting results on the effect of Etanercept in insulin-resistance, etanercept have shown an interesting action on reducing serum insulin levels and improving insulin sensitivity. Similar to Infliximab, Etanercept does not significantly modify lipid profiles; furthermore, PsO patients treated by etanercept gradually and progressively

Adalimumab is human monoclonal antibody against TNF-alpha (Staidle JP et al, 2011).

Although there are no reports in literature discussing about adalimumab effect on insulin resistance or sensitivity in PsO patients, a recent case revealed episodes of hyperglycemia in

gain weight, in particular lean ones (Marra M et al, 2007).

(PsA), little is known about their effects on the MetS components in PsO patients.

arthritis (PsA): infliximab, etanercept, and adalimumab (Channual J et al, 2009).

significantly increased in the presence of elevated CRP levels (Gottlieb A et al, 2008).

**9. Anti-TNF-alpha in psoriasis and metabolic syndrome** 

(Channual J et al, 2009).

alpha (Staidle JP et al, 2011).

sensitivity in PsO patients.

(Saraceno R et al, 2009).

2003).

pathological entities (Channual J et al, 2009).

Despite further studies on anti-TNF-alpha drug effect on MetS syndrome are required, an examination of literature data suggest that the combined effects of improved insulin resistance and sensitivity and a significant reduction in systemic inflammation may interrupt inflammatory cascade linking PsO and MetS.

Taking into consideration the high potentiality of biological therapies to reduce the metabolic effect of TNF-alpha, the future goal might be to demonstrate a real in vivo preventing effect on development of cardiovascular comorbidities in Pso/PsA patients. For these reason other longitudinal long term clinical studies are needed.
