A double-edged sword: ROS related therapies in the treatment of psoriasis

Abstract

In the onset and progression of psoriasis, redox imbalance is a vital factor. It's widely accepted that too much reactive oxygen species (ROS) always make psoriasis worse. Recent research, however, has shown that the accumulation of ROS is not entirely detrimental, as it helps reduce psoriasis lesions by inhibiting epidermal proliferation and keratinocyte death. As a result, ROS appears to have two opposing effects on the treatment of psoriasis. In this review, the current ROS-related therapies for psoriasis, including basic and clinical research, are presented. Additionally, the design and therapeutic benefits of various drug delivery systems and therapeutic approaches are examined, and a potential balance between anti-oxidative stress and ROS accumulation is also trying to be investigated.

Keywords: Antioxidant; Psoriasis; ROS accumulation; ROS related therapies.

Graphical abstract

Fig. 1

Oxidative stress is one of the important factors in causing psoriasis. It has various damages to the body including abnormal angiogenesis, neutrophil recruitment and excessive proliferation of keratinocytes.

Fig. 2

Liquid preparations used to treat psoriasis by alleviating oxidative stress. (I): Mechanism diagram of quercetin in the treatment of psoriasis (A); Macro images of the backs of mice 7 d after treating with quercetin (B). (Reproduced with permission from , Copyright© 2017 Elsevier B.V.); (II): Summary image of ambroxol for the treatment of psoriasis (A); Macroscopic image of mice back on the seventh day of treatment (B); A schematic diagram represents ambroxol's molecular mechanism against psoriasis (C). (Reproduced with permission from , Copyright© 2019 Elsevier B.V.). (III): Mechanism diagram of perillyl alcohol to improving psoriasis (A); Quantitative analysis of intracellular ROS levels after treating with perillyl alcohol (B); Macro images of the skin surface on the seventh day treating with perillyl alcohol (C). (Reproduced with permission from , Copyright© 2021 Elsevier B.V.).

Fig. 3

Nano preparations used to treat psoriasis by alleviating oxidative stress. (I): BRNPs (Reproduced with permission from , Copyright© 2020, Elsevier B.V.); (II): MBNs (Reproduced with permission from , Copyright© 2022, The Royal Society of Chemistry). (III): A "sugar gourd"-like nanoplatform co-loaded with bilirubin and JPH203 (Reproduced with permission from , Copyright© 2021 Elsevier B.V.). (IV): Ethosomes co-loaded with GA and Cur (Reproduced with permission from , Copyright © 2021 Elsevier B.V.).

Fig. 4

Excessive accumulation of ROS in the volume can induce apoptosis and inhibit tumors. In psoriasis, apoptosis mediated by ROS leads to normalization of the epidermis, as a result, improving symptoms in patient.

Fig. 5

Drugs based on ROS generation for the treatment of psoriasis. (I): The in vivo fate map of CHALT (A). Generation of ROS in different groups under fluorescence (B). The experimental design and the macroscopic images of psoriatic mice backs after seven days of CHALT treatment (C). (Reproduced with permission from , Copyright ©2022, Shenyang Pharmaceutical University). (II): Mechanism of SeNPs in the treatment of psoriasis (A). (B): (a) Changes in mitochondrial membrane redox potential by SeNPs assessed by JC-1 staining. (b) DCFDA staining to determine the level of oxidative stress induced by SeNPs. (Reproduced with permission from , Copyright © 2021, The Authors). (ⅠII): Ultrastructural changes of HaCaT cells after periplogenin treatment (A). Perilogenin reduces skin inflammation and hyperplasia in a TPA-induced mouse model. Macro view of mice ears and backs at the end of the experiment (B). (Reproduced with permission from , Copyright © 2016 Elsevier Inc.).

Fig. 6

Therapeutic strategies based on ROS aggregation. (I): (A) and (B) HBOT increased the expression of IDO in healthy mice, indicating that ROS levels in tissue are elevated. (C) Macro view of mice backs. (Reproduced with permission from , Copyright ©2014 Kim et al.). (II): N₃ -NV-INPs enhanced PDT in psoriasis. (A) Schematic representation of N₃ -NV-INPs. (B) N₃ -NV-INPs promote ROS generation. (C) In vivo imaging of mice after treating with N3-NV-INPs. (D) Macro images of mouse backs after treating with different drugs. (Reproduced with permission from , Copyright © 2021 Elsevier Ltd.).

Fig. 7

Clinical studies on ROS-based treatment of psoriasis. (Ⅰ): Clinical evaluation of a patient after four weeks of hydrogen bath treatment. (Reproduced with permission from , Copyright © 2018 The AuthorS). (II): Potential mechanisms of action of tapinarof in the treatment of psoriasis. (Reproduced with permission from , Copyright ©2020 Elsevier Inc.).