Expression of Th1 and Th2 Cytokine and Associated Transcription Factors in Peripheral Blood Mononuclear Cells and Correlation with Disease Severity

Psoriasis is a T cell-mediated autoimmune disease with elevated level of pro-inflammatory cytokines belonging mainly to Th1 pathway. We investigated whether treatment with micronutrients along with methotrexate (MTX) is able to modulate mRNA expression of Th1 and Th2 patterns and its correlation with disease severity. Thirty plaque type psoriasis patients with Psoriasis Area and Severity Index (PASI) higher than 10 recruited; 15 non- micronutrients taker (NMT) patients, treated by MTX daily (0.2-0.3 mg/kg/week) and 15 micronutrients taker (MT) patients treated by MTX plus micronutrient supplement daily for 12 weeks. Blood samples collected at baseline and after 12 weeks. Taqman quantitative real-time polymerase chain reaction was applied to analyses the expression of Th1 (T-bet, IL-12, IFN- γ) and Th2 (GATA-3, IL-4) pathway. Disease severity measured under PASI scoring system. Significant clinical improvement in MT group was accordance with significant down-regulation of Th1 and up-regulation of Th2 studied markers (P<0.05). Respect to PASI-75 cut-point, expression of IFN-γ in MT group with upper PASI-75 was significantly lower than in related patients in NMT group (P=0.05). Also mRNA expressions of GATA3 and IL-4 in MT group with upper PASI-75 were significantly higher than patients in NMT group respectively (P=0.05, P=0.04) According to significant attenuating of PASI score correlated with upregulation of Th2 pathway in favor of MT group, consumption of micronutrients in combination MTX in psoriasis patients are suggested. Our results contribute to a better understanding of methotrexate immune-pathogenesis mechanisms and its correlation to clinical response in psoriasis.