Acne Vulgaris Clinical Trial
Official title:
Serum apelin12 in Acne Vulgaris
Acne vulgaris is a common chronic inflammatory disease of the pilosebaceous unit which is
characterized by the formation of non-inflammatory open and closed comedones and inflammatory
papules, pustules, nodules and cysts.
It is a multifactorial disease that affects mostly adolescent population. Acne appears very
early in puberty during the preteen years, often before menarche in girls. Because many
adolescents have acne, it is difficult to predict which individuals are prone to severe
cases.
The pathogenesis of acne is complex, with strong evidence supporting the involvement of
follicular hyperkeratinization, hyperactivity of the sebaceous glands, colonization of
Propionibacterium acnes and yeast, and inflammation. Although the importance of androgens in
the pathophysiology of acne has been supported by both clinical studies and experimental
data, the research evaluating adipokines are very few in patients with acne vulgaris.
Acne lesions may vary in number during the natural course of the disease and multiple
measurements have been developed which is based on clinical examination and photographic
documentation, to measure the clinical severity.
The Grading of acne based on the type of lesions, affected surface area and their severity
that can help in deciding which therapies are needed in each individual. However, no grading
system has been accepted universally. The Global Acne Grading System is a quantitative
scoring system to assess the severity of acne. According to this score acne was graded as
mild, moderate, severe and very severe.
The severity of acne was also graded using the Comprehensive Acne Severity Scale.
Adipokines are proteins that are synthesized and secreted primarily by adipocytes in response
to various stimuli, include interleukin 6 and other small molecular weight bioactive proteins
such as adiponectin, resistin, leptin, serpin E1 [also known as plasminogen activator
inhibitor 1 and endothelial plasminogen activator inhibitor], visfatin (also known as
nicotinamide phosphoribosyltransferase), apelin, chemerin, retinol binding protein 4, and
monocyte chemoattractant protein 1.
Due to their different biological properties and diverse cellular targets adipokines are
involved in a wide array of (patho)physiological processes and are responsible for mediating
the inflammatory effects of the adipose tissue in the local tissue environment as well as to
different organs via circulation. By detecting alterations in their serum levels also in
dermatological diseases such as acne vulgaris and psoriasis, extensive studies have also
started in dermatological research to identify the possible targets and the cutaneous sources
of these proteins.
Apelin is an endogenous ligand of the previously discovered "orphan" receptor named APJ,
isolated from bovine stomach extracts.
It is a product of apelin gene that is located on chromosome Xq25-26.1 and translated as a 77
amino acid prepropeptide. It is processed into several active molecular forms with different
biological activities. Apelin belongs to adipokines group because its m-RNA expression has
been demonstrated in mature adipocytes in rodents and humans.
Apelin peptide expression has been also demonstrated in several tissues and seems to have
different regulatory functions, depending on the expressing tissue, the apelinergic system
distribution over such a variety of tissues has suggested that it might play relevant roles
in human physiology.
Apelin has been reported to have an effect on appetite, drinking behavior, angiogenesis, and
the cardiovascular system. It is regulated by insulin. Apelin might be a novel target for
preventing obesity and obesity-related diseases via enhancement of vascular integrity.
Several active apelin forms exist such as apelin-36, apelin-17, apelin-13, and apelin-12.
Apelin-12 is a 12-amino peptide fragment that has been implicated in reducing blood pressure
via a nitric oxide mechanism, and is involved in feeding mechanisms via stimulation of
cholecystokinin secretion.
It is considered to be one of the most potent isoform of apelin.
The studies evaluating the role of adipokines are very few in patient with acne vulgaris.
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