**5.2 Anti-interleukin 22**

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TNF alpha antibodies on synovial cell interleukin-1 production in rheumatoid

inflammation via several transcription factors such as STAT3 (Nograles et al, 2009). ILV-094 is a fully human anti IL-22 monoclonal antibody. A phase I study to evaluate the efficacy and safety of ILV-094 in psoriasis has been recently completed, while it is currently ongoing a phase II trial for rheumatoid arthritis (Pfizer, 2010).

#### **5.3 Chaperonin 10**

Chaperonin 10 belongs to the heat shock proteins family and acts as a molecular chaperon, regulating protein folding. Several studies support its anti-inflammatory activity and its role in down-regulating the excessive immune response (van Eden, 2008). Recombinant Chaperonin 10 (Cpn10) mimics these activities and its efficacy in psoriasis has been evaluated by a single-center, double-blind exploratory study, showing a significant improvement in Cpn10-treated patients (Williams et al, 2008). Phase II trials have been completed for psoriasis, rheumatoid arthritis and multiple sclerosis (Golant & Gutman-Yassky, 2011).

#### **5.4 Small RNA drugs**

The use of RNA interference as a drug is one of the possible therapeutic strategies to target the pro-inflammatory cytokines involved in psoriasis, as shown by several phase I and II ongoing clinical trials (reviewed in Jackson et al, 2006). On the basis of their role in psoriasis, suitable mRNA targets are TNF, IL-20 and IL-23. A recent study showed that local small RNA therapy against TNF provided amelioration in psoriasis in a xenograft transplantation model (Jakobsen et al, 2009). These results indicate that RNA interference is a potential therapy in the treatment of inflammatory skin diseases. Nevertheless the main challenge for this kind of therapy remains the delivery of small RNA.

### **6. Conclusion**

The introduction of biological drugs in clinical practice has revolutionized the treatment of psoriasis and psoriatic arthritis in the last decade. Biologics have shown to be effective and to have an acceptable safety profile, but there is still a need to assess long-term toxicity through clinical experience and careful post-marketing surveillance.

### **7. References**


inflammation via several transcription factors such as STAT3 (Nograles et al, 2009). ILV-094 is a fully human anti IL-22 monoclonal antibody. A phase I study to evaluate the efficacy and safety of ILV-094 in psoriasis has been recently completed, while it is currently ongoing

Chaperonin 10 belongs to the heat shock proteins family and acts as a molecular chaperon, regulating protein folding. Several studies support its anti-inflammatory activity and its role in down-regulating the excessive immune response (van Eden, 2008). Recombinant Chaperonin 10 (Cpn10) mimics these activities and its efficacy in psoriasis has been evaluated by a single-center, double-blind exploratory study, showing a significant improvement in Cpn10-treated patients (Williams et al, 2008). Phase II trials have been completed for psoriasis, rheumatoid arthritis and multiple sclerosis (Golant & Gutman-

The use of RNA interference as a drug is one of the possible therapeutic strategies to target the pro-inflammatory cytokines involved in psoriasis, as shown by several phase I and II ongoing clinical trials (reviewed in Jackson et al, 2006). On the basis of their role in psoriasis, suitable mRNA targets are TNF, IL-20 and IL-23. A recent study showed that local small RNA therapy against TNF provided amelioration in psoriasis in a xenograft transplantation model (Jakobsen et al, 2009). These results indicate that RNA interference is a potential therapy in the treatment of inflammatory skin diseases. Nevertheless the main

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**17** 

*Brazil* 

**Food, Nutrition and Diet Therapy in Psoriasis** 

Diet has been suggested to play a role in the etiology and pathogenesis of psoriasis (Araujo et al., 2009; Wolters, 2005). Periods of fasting, a hypocaloric and vegetarian diet have been associated with an improvement in symptoms due to changes in the metabolism of polyunsaturated fatty acids (PUFAs) and an influence on the profile of eicosanoids, leading to suppression of the inflammatory process (Lithell et al., 1983; Rucevic et al., 2003; Wolters, 2005). The consumption of alcoholic beverages is prevalent among patients with psoriasis and is the greatest cause of the high mortality rate among individuals with moderate to severe forms of the disease and should therefore be avoided (Chistophers, 2001; Poikolainen et al., 1990; Smith & Fenske, 2000; Wolters, 2005). According to several authors, calcitriol (the active form of vitamin D) and its analogs have anti-proliferation, pro-differentiation and immune-regulating properties that may inhibit the growth and maturation of keratinocytes, with oral supplementation often suggested for patients who do not topically use calcitriol

The skin acts as an interface between the body and surrounding environment, thus the skin is constantly exposed to both endogenous and exogenous pro-oxidants, leading to the generation of harmful oxidant species. Oxidative stress and the generation of excessive free radicals have been related to skin inflammation in psoriasis. Patients with this condition have reduced plasma levels of β-carotene and α-tocopherol as well as a decline in serum selenium and high concentrations of malondialdehyde, which is a marker of lipid peroxidation in the plasma and red blood cells (Briganti & Picardo, 2003; Azzini et al., 1995;

Data from literature indicates that the topical application or oral administration of antioxidants is suggested as preventive therapy for the natural aging of the skin and cancer caused by ultraviolet rays (Briganti & Picardo, 2003). With regard to lipids, studies have demonstrated the anti-inflammatory effect of fish oil in individuals with psoriasis, as diets rich in omega 3 modify the metabolism of PUFAs, thereby influencing the profile of eicosanoids, which leads to the suppression of the inflammatory process (Smith & Fenske, 2000). A number of authors report an association between latent sensitivity to gluten (preceliac disease state) and different skin diseases, including psoriasis, suggesting a gluten-free diet may provide beneficial effects (Duggan, 2004; Humbert et al., 2006; Leffler et al., 2003;

**1. Introduction** 

Serwin et al., 2003).

(Andorini, 2002; Holick, 2003; Wolters, 2005).

Michaelsson et al., 2003; Nelson, 2002; Wolters, 2005).

Maria Lucia Diniz Araujo, Paulla Suylane Santos Fernandes Costa

and Maria Goretti Pessoa de Araujo Burgos

*Federal University of the Pernambuco* 

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