1 5655 148 SEX-BASED MEDICINE MEETS PSORIATIC ARTHRITIS: LESSONS LEARNED AND TO LEARN. HUMORALLY ASSOCIATED AUTOIMMUNE DISEASES GENERALLY SHOW A FEMALE PREDOMINANCE WHEREAS ANKYLOSING SPONDYLITIS, A DISEASE THAT OVERLAPS WITH PSORIATIC ARTHRITIS (PSA), SHOWS A MALE PREDOMINANCE. THE PRESENT REVIEW ASCERTAINS THE CURRENT KNOWLEDGE OF SEX-SPECIFIC DIFFERENCES RELATED TO PSORIATIC ARTHRITIS (PSA), A CHRONIC, INFLAMMATORY CONDITION ASSOCIATED WITH PSORIASIS. SEX DIFFERENCES MAY HAVE IMPORTANT IMPLICATIONS FOR CLINICAL RESEARCH IN PSA AND IN TERMS OF EPIDEMIOLOGY (INCIDENCE, PREVALENCE, LIFETIME RISK, SURVIVAL, AND MORTALITY), CLINICAL, RADIOLOGICAL, AND LABORATORY FEATURES, AND RESPONSE TO TREATMENT. WHILE NATIONWIDE SURVEYS AND LARGE-SCALE DATABASES AND REGISTRIES SHOW NO SEX-SPECIFIC DIFFERENCES, VARYING MALE/FEMALE RATIOS HAVE BEEN REPORTED, RANGING FROM 0.42 TO 2.75 (COMPARABLE WITH THOSE REPORTED FOR PSORIASIS VULGARIS: RANGING FROM 0.28 TO 2.38). THIS MAY REFLECT SUBTLE, COMPLEX, NONLINEAR INTERACTIONS BETWEEN THE BIOLOGICAL MAKE-UP OF THE INDIVIDUAL (GENETIC AND EPIGENETIC DIFFERENCES), HORMONAL COMPONENTS INCLUDING MENOPAUSAL STATUS, ENVIRONMENTAL EXPOSURES INCLUDING SKELETAL PHYSICAL STRESSING, AND PSYCHOLOGICAL VARIABLES. THERE EXISTS METHODOLOGICAL HETEROGENEITY AND PAUCITY OF DATA CONCERNING SEX-SPECIFIC DIFFERENCES, IN TERMS OF THE SPECIFIC POPULATION STUDIED, STUDY DESIGN, AND THE DIAGNOSTIC CRITERIA UTILIZED. HARMONIZING AND RECONCILING THESE DISCREPANCIES WOULD BE OF CRUCIAL IMPORTANCE IN ACHIEVING THE AMBITIOUS GOALS OF PERSONALIZED/INDIVIDUALIZED MEDICINE AND FURTHER STANDARDIZED META-DATA AND BIG DATA COULD HELP DISENTANGLE AND ELUCIDATE THE PRECISE MECHANISMS OF UNDERLYING POTENTIAL PSA SEX-SPECIFIC DIFFERENCES. 2022 2 4962 34 PATHOGENESIS OF PSORIATIC ARTHRITIS. PSORIATIC ARTHRITIS (PSA) IS A CHRONIC INFLAMMATORY ARTHROPATHY INVOLVING SYNOVIAL AND ENTHESEAL STRUCTURES, ASSOCIATED WITH PSORIASIS OR SIMILAR CONDITIONS. THE ETIOPATHOGENETIC MECHANISMS UNDERLYING PSA REMAIN UNCLARIFIED. THE MOST ACCREDITED HYPOTHESIS INVOLVES A COMPLEX INTERACTION AMONG GENETIC, ENVIRONMENTAL, AND IMMUNOLOGICAL FACTORS. ENVIRONMENTAL AGENTS, PARTICULARLY TRAUMA, MECHANICAL STRESS, AND SMOKE HAVE BEEN CITED AS POSSIBLE FACTORS IN TRIGGERING THE DISEASE IN GENETICALLY PREDISPOSED SUBJECTS. LIKE OTHER FORMS OF SPONDYLOARTHROPATHIES, PSA SHOWS SEVERAL GENETIC ASSOCIATIONS WITH THE MAJOR HISTOCOMPATIBILITY COMPLEX (MHC) CLASS I ALLELES LOCATED ON CHROMOSOME 6P21.3, PARTICULARLY THE HUMAN LEUKOCYTE ANTIGEN (HLA)-B27 IN AXIAL PHENOTYPES. RECENT STUDIES HAVE DEMONSTRATED THAT THE MOST COMMON EPIGENETIC MECHANISMS THAT REGULATE GENE EXPRESSION IN PSA ARE REPRESENTED BY DNA METHYLATION, PARENT OF ORIGIN EFFECT OR GENOMIC IMPRINTING, EXPRESSION OR ACTIVITY OF EPIGENETIC MODIFYING ENZYMES, AND RNA INTERFERENCE (RNAI) BY MICRORNAS (MIRNAS). THE MECHANISMS UNDERLYING PSA PATHOGENESIS ACTIVATE THE INNATE AND ADAPTIVE IMMUNE SYSTEM AND OVEREXPRESSION OF TNF ASSOCIATED WITH AMPLIFICATION OF THE IL-23/IL-17 AXIS. IN RECENT YEARS, MORE PSA SUSCEPTIBILITY GENES AND EPIGENETIC MECHANISMS HAVE BEEN IDENTIFIED. ADVANCES IN THE KNOWLEDGE OF INNATE AND ADAPTIVE IMMUNE MECHANISMS UNDERLYING PSA HAVE CONTRIBUTED TO A BETTER UNDERSTANDING OF THE HETEROGENEOUS CLINICAL EXPRESSION OF THE DISEASE AND, THUS, TO THERAPY STRATEGIES. THE COMPLEXITY OF THE PATHOGENETIC ASPECTS INVOLVING MULTIPLE CYTOKINES, CELL LINES, AND MOLECULES NEEDS TO BE FURTHER INVESTIGATED TO ADVANCE PERSONALIZED THERAPEUTIC STRATEGIES AND TO IMPROVE OUTCOMES OF PATIENTS AFFECTED BY PSA. 2019 3 631 26 BIOLOGICAL AND SYNTHETIC TARGET DMARDS IN PSORIATIC ARTHRITIS. PSORIATIC ARTHRITIS (PSA) IS A CHRONIC MULTI-FACETED IMMUNE-MEDIATED SYSTEMIC DISORDER, CHARACTERIZED BY ARTICULAR, CUTANEOUS, ENTHESIS, NAIL AND SPINE INVOLVEMENT. ARTICULAR MANIFESTATIONS OF PSA ARE PARTICULARLY COMMON AND HIGHLY DISABLING FOR PATIENTS, WHILE THE HETEROGENEOUS CLINICAL SUBSETS OF THE DISEASE ARE CHALLENGING FOR CLINICIANS. IN RECENT YEARS, RESEARCH HAS MADE MANY ADVANCES IN UNDERSTANDING THE PATHOGENESIS OF THE DISEASE FROM GENETIC, EPIGENETIC AND MOLECULAR POINTS OF VIEW. NEW DRUGS ARE NOW AVAILABLE FOR THE TREATMENT OF THIS CONDITION, AND, IN PARTICULAR, TNF-ALFA INHIBITORS, HISTORICALLY THE FIRST BIOLOGICALS APPROVED IN PSA, ARE NOW JUXTAPOSED BY NEW BIOLOGICAL DISEASE MODIFYING ANTI-RHEUMATIC DRUGS (BDMARDS) WITH DIFFERENT MODES OF ACTION. TARGETING IL-12/IL-23 P40 COMMON SUBUNIT WITH USTEKINUMAB, IL-17A WITH SECUKINUMAB AND IXEKIZUMAB, T CELLS CO-STIMULATION WITH ABATACEPT, IS NOW POSSIBLE, SAFE AND EFFECTIVE. MOREOVER, TARGETED SYNTHETIC MOLECULES WITH ORAL ADMINISTRATION ARE AVAILABLE, WITH THE POSSIBILITY TO INTERFERE WITH PHOSPHODIESTERASE-4 AND JAK/STAT PATHWAYS. INDEED, NEW DRUGS ARE UNDER DEVELOPMENT, WITH THE POSSIBILITY TO TARGET SELECTIVELY IL-17 RECEPTOR, IL-23, AND OTHER KEY MOLECULAR TARGETS IN THE PATHOGENESIS OF THIS CONDITION. IN THIS NARRATIVE REVIEW, WE PROVIDE AN UP-TO-DATE OVERVIEW OF THE CURRENT APPLICATION OF BIOLOGICAL AND TARGETED SYNTHETIC DMARDS IN THE FIELD OF PSA, WITH PARTICULAR REGARD TO THE CLINICAL SIGNIFICANCE OF THIS POSSIBILITY TO TARGET A HIGHER NUMBER OF DISTINCT IMMUNE-PATHWAYS. 2019 4 1570 35 DNA METHYLATION PATTERNS IN CD4(+) T-CELLS SEPARATE PSORIASIS PATIENTS FROM HEALTHY CONTROLS, AND SKIN PSORIASIS FROM PSORIATIC ARTHRITIS. BACKGROUND: PSORIASIS IS AN AUTOIMMUNE/INFLAMMATORY DISORDER PRIMARILY AFFECTING THE SKIN. CHRONIC JOINT INFLAMMATION TRIGGERS THE DIAGNOSIS OF PSORIATIC ARTHRITIS (PSA) IN APPROXIMATELY ONE-THIRD OF PSORIASIS PATIENTS. ALTHOUGH JOINT DISEASE TYPICALLY FOLLOWS THE ONSET OF SKIN PSORIASIS, IN AROUND 15% OF CASES IT IS THE INITIAL PRESENTATION, WHICH CAN RESULT IN DIAGNOSTIC DELAYS. THE PATHOPHYSIOLOGICAL MECHANISMS UNDERLYING PSORIASIS AND PSA ARE NOT YET FULLY UNDERSTOOD, BUT THERE IS EVIDENCE POINTING TOWARDS EPIGENETIC DYSREGULATION INVOLVING CD4(+) AND CD8(+) T-CELLS. OBJECTIVES: THE AIM OF THIS STUDY WAS TO INVESTIGATE DISEASE-ASSOCIATED DNA METHYLATION PATTERNS IN CD4(+) T-CELLS FROM PSORIASIS AND PSA PATIENTS THAT MAY REPRESENT POTENTIAL DIAGNOSTIC AND/OR PROGNOSTIC BIOMARKERS. METHODS: PBMCS WERE COLLECTED FROM 12 PATIENTS WITH CHRONIC PLAQUE PSORIASIS AND 8 PSA PATIENTS, AND 8 HEALTHY CONTROLS. CD4(+) T-CELLS WERE SEPARATED THROUGH FACS SORTING, AND DNA METHYLATION PROFILING WAS PERFORMED (ILLUMINA EPIC850K ARRAYS). BIOINFORMATIC ANALYSES, INCLUDING GENE ONTOLOGY (GO) AND KEGG PATHWAY ANALYSIS, WERE PERFORMED USING R. TO IDENTIFY GENES UNDER THE CONTROL OF INTERFERON (IFN), THE INTERFEROME DATABASE WAS CONSULTED, AND DNA METHYLATION SCORES WERE CALCULATED. RESULTS: NUMBERS AND PROPORTIONS OF CD4(+) T-CELL SUBSETS (NAIVE, CENTRAL MEMORY, EFFECTOR MEMORY, CD45RA RE-EXPRESSING EFFECTOR MEMORY CELLS) DID NOT VARY BETWEEN CONTROLS, SKIN PSORIASIS AND PSA PATIENTS. 883 DIFFERENTIALLY METHYLATED POSITIONS (DMPS) AFFECTING 548 GENES WERE IDENTIFIED BETWEEN CONTROLS AND "ALL" PSORIASIS PATIENTS. PRINCIPAL COMPONENT AND PARTIAL LEAST-SQUARES DISCRIMINANT ANALYSIS SEPARATED CONTROLS FROM SKIN PSORIASIS AND PSA PATIENTS. GO ANALYSIS CONSIDERING PROMOTER DMPS DELIVERED HYPERMETHYLATION OF GENES INVOLVED IN "REGULATION OF WOUND HEALING, SPREADING OF EPIDERMAL CELLS", "NEGATIVE REGULATION OF CELL-SUBSTRATE JUNCTION ORGANIZATION" AND "NEGATIVE REGULATION OF FOCAL ADHESION ASSEMBLY". COMPARING CONTROLS AND "ALL" PSORIASIS, A MAJORITY OF DMPS MAPPED TO IFN-RELATED GENES (69.2%). NOTABLY, DNA METHYLATION PROFILES ALSO DISTINGUISHED SKIN PSORIASIS FROM PSA PATIENTS (2,949 DMPS/1,084 GENES) THROUGH GENES AFFECTING "CAMP-DEPENDENT PROTEIN KINASE INHIBITOR ACTIVITY" AND "CAMP-DEPENDENT PROTEIN KINASE REGULATOR ACTIVITY". TREATMENT WITH CYTOKINE INHIBITORS (IL-17/TNF) CORRECTED DNA METHYLATION PATTERNS OF IL-17/TNF-ASSOCIATED GENES, AND METHYLATION SCORES CORRELATED WITH SKIN DISEASE ACTIVITY SCORES (PASI). CONCLUSION: DNA METHYLATION PROFILES IN CD4(+) T-CELLS DISCRIMINATE BETWEEN SKIN PSORIASIS AND PSA. DNA METHYLATION SIGNATURES MAY BE APPLIED FOR QUANTIFICATION OF DISEASE ACTIVITY AND PATIENT STRATIFICATION TOWARDS INDIVIDUALIZED TREATMENT. 2023 5 67 31 A LONGITUDINAL STUDY OF THE ASSOCIATIONS OF BDNF GENOTYPE AND METHYLATION WITH POSTSTROKE ANXIETY. BACKGROUND: ALTHOUGH THE PRECISE ETIOLOGY OF POSTSTROKE ANXIETY (PSA) HAS YET TO BE FULLY ELUCIDATED, IT IS KNOWN THAT BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) IS IMPORTANT FOR NEURAL PLASTICITY AND LONG-TERM POTENTIATION, ASSOCIATED WITH THE PATHOPHYSIOLOGY OF ANXIETY. THE EXPRESSION OF BDNF IS REGULATED BY EPIGENETIC AND GENETIC PROFILES. THUS, WE INVESTIGATED THE ASSOCIATION BETWEEN BDNF METHYLATION STATUS AND PSA AT 2 WEEKS AND 1 YEAR AFTER STROKE WHILE ACCOUNTING FOR INTERACTIONS WITH THE BDNF VAL66MET POLYMORPHISM. METHODS: THE BASELINE SAMPLE COMPRISED 286 PATIENTS WHO WERE ASSESSED AT 2 WEEKS AFTER STROKE; OF THESE PATIENTS, 222 (78%) WERE FOLLOWED UP WITH AT 1 YEAR AFTER STROKE. THE PRESENCE OF PSA WAS DETERMINED USING THE ANXIETY SUBSCALE OF THE HOSPITAL ANXIETY AND DEPRESSION SCALE (HADS), AND THE EFFECTS OF BDNF METHYLATION STATUS AND POLYMORPHISMS ON PSA STATUS WERE ASSESSED WITH MULTIVARIATE LOGISTIC REGRESSION MODELS. RESULTS: THE PREVALENCE OF PSA WAS SLIGHTLY LOWER (27 [9.4%]) AT BASELINE, AND 35 (15.8%) PATIENTS WERE IDENTIFIED AS HAVING PSA AT THE 1-YEAR FOLLOW-UP. STROKE PATIENTS WITH A HIGHER AVERAGE METHYLATION STATUS WERE MORE LIKELY TO HAVE PSA AT 1 YEAR. THE BDNF VAL66MET POLYMORPHISM WAS NOT INDEPENDENTLY ASSOCIATED WITH PSA DURING EITHER THE ACUTE OR CHRONIC PHASE AFTER STROKE, BUT THERE WAS A SIGNIFICANT INTERACTIVE EFFECT BETWEEN BDNF METHYLATION AND GENOTYPE ON PSA AT 2 WEEKS. CONCLUSIONS: IN THIS STUDY, BDNF METHYLATION IN COMBINATION WITH THE MET/MET BDNF POLYMORPHISM (VAL66MET POLYMORPHISM) WAS ASSOCIATED WITH PSA. THESE FINDINGS MAY HELP IDENTIFY PATIENTS AT HIGHER RISK FOR PSA. 2019 6 1571 32 DNA METHYLATION PATTERNS IN CD8(+) T CELLS DISCERN PSORIASIS FROM PSORIATIC ARTHRITIS AND CORRELATE WITH CUTANEOUS DISEASE ACTIVITY. BACKGROUND: PSORIASIS IS A T CELL-MEDIATED CHRONIC AUTOIMMUNE/INFLAMMATORY DISEASE. WHILE SOME PATIENTS EXPERIENCE DISEASE LIMITED TO THE SKIN (SKIN PSORIASIS), OTHERS DEVELOP JOINT INVOLVEMENT (PSORIATIC ARTHRITIS; PSA). IN THE ABSENCE OF DISEASE- AND/OR OUTCOME-SPECIFIC BIOMARKERS, AND AS ARTHRITIS CAN PRECEDE SKIN MANIFESTATIONS, DIAGNOSTIC AND THERAPEUTIC DELAYS ARE COMMON AND CONTRIBUTE TO DISEASE BURDEN AND DAMAGE ACCRUAL. OBJECTIVE: ALTERED EPIGENETIC MARKS, INCLUDING DNA METHYLATION, CONTRIBUTE TO EFFECTOR T CELL PHENOTYPES AND ALTERED CYTOKINE EXPRESSION IN AUTOIMMUNE/INFLAMMATORY DISEASES. THIS PROJECT AIMED AT THE IDENTIFICATION OF DISEASE-/OUTCOME-SPECIFIC DNA METHYLATION SIGNATURES IN CD8(+) T CELLS FROM PATIENTS WITH PSORIASIS AND PSA AS COMPARED TO HEALTHY CONTROLS. METHOD: PERIPHERAL BLOOD CD8(+) T CELLS FROM NINE HEALTHY CONTROLS, 10 PSORIASIS, AND SEVEN PSA PATIENTS WERE COLLECTED TO ANALYZE DNA METHYLATION MARKS USING ILLUMINA HUMAN METHYLATION EPIC BEADCHIPS (>850,000 CPGS PER SAMPLE). BIOINFORMATIC ANALYSIS WAS PERFORMED USING R (MINFI, LIMMA, CHAMP, AND DMRCATE PACKAGES). RESULTS: DNA METHYLATION PROFILES IN CD8(+) T CELLS DIFFERENTIATE HEALTHY CONTROLS FROM PSORIASIS PATIENTS [397 DIFFERENTIALLY METHYLATED POSITIONS (DMPS); 9 DIFFERENTIALLY METHYLATED REGIONS (DMRS) WHEN >/=CPGS PER DMR WERE CONSIDERED; 2 DMRS FOR >/=10 CPGS]. FURTHERMORE, PATIENTS WITH SKIN PSORIASIS CAN BE DISCRIMINATED FROM PSA PATIENTS [1,861 DMPS, 20 DMRS (>/=5 CPGS PER REGION), 4 DMRS (>/=10 CPGS PER REGION)]. GENE ONTOLOGY (GO) ANALYSES CONSIDERING GENES WITH >/=1 DMP IN THEIR PROMOTER DELIVERED METHYLATION DEFECTS IN SKIN PSORIASIS AND PSA PRIMARILY AFFECTING THE BMP SIGNALING PATHWAY AND ENDOPEPTIDASE REGULATOR ACTIVITY, RESPECTIVELY. GO ANALYSIS OF GENES ASSOCIATED WITH DMRS BETWEEN SKIN PSORIASIS AND PSA DEMONSTRATED AN ENRICHMENT OF GABAERGIC NEURON AND CORTEX NEURON DEVELOPMENT PATHWAYS. TREATMENT WITH CYTOKINE BLOCKERS ASSOCIATED WITH DNA METHYLATION CHANGES [2,372 DMPS; 1,907 DMPS WITHIN PROMOTERS, 7 DMRS (>/=5 CPG PER REGIONS)] AFFECTING TRANSFORMING GROWTH FACTOR BETA RECEPTOR AND TRANSMEMBRANE RECEPTOR PROTEIN SERINE/THREONINE KINASE SIGNALING PATHWAYS. LASTLY, A METHYLATION SCORE INCLUDING TNF AND IL-17 PATHWAY ASSOCIATED DMPS INVERSE CORRELATES WITH SKIN DISEASE ACTIVITY SCORES (PASI). CONCLUSION: PATIENTS WITH SKIN PSORIASIS EXHIBIT DNA METHYLATION PATTERNS IN CD8(+) T CELLS THAT ALLOW DIFFERENTIATION FROM PSA PATIENTS AND HEALTHY INDIVIDUALS, AND REFLECT CLINICAL ACTIVITY OF SKIN DISEASE. THUS, DNA METHYLATION PROFILING PROMISES POTENTIAL AS DIAGNOSTIC AND PROGNOSTIC TOOL TO BE USED FOR MOLECULAR PATIENT STRATIFICATION TOWARD INDIVIDUALIZED TREATMENT. 2021 7 4319 23 MICRORNAS IN AXIAL SPONDYLARTHRITIS: AN OVERVIEW OF THE RECENT PROGRESSES IN THE FIELD WITH A FOCUS ON ANKYLOSING SPONDYLITIS AND PSORIATIC ARTHRITIS. PURPOSE OF REVIEW: TO HIGHLIGHT THE RECENT DISCOVERIES AND LINES OF EVIDENCE ON THE ROLE OF MICRORNAS IN ANKYLOSING SPONDYLITIS (AS) AND PSORIATIC ARTHRITIS (PSA), FOCUSING ON THEIR EXPRESSION PROFILING AND MECHANISMS OF ACTION. RECENT FINDINGS: AS AND PSA ARE CHRONIC INFLAMMATORY MUSCULOSKELETAL DISEASES WITH AXIAL MANIFESTATIONS AND REPRESENT AN EXCELLENT MODEL FOR STUDYING MICRORNAS CONTRIBUTION TO THE DISEASE PATHOGENESIS, PARTICULARLY THROUGH IMMUNOMODULATION, INFLAMMATION, AND BONE REMODELLING, OR THEIR VALUE AS CANDIDATE DIAGNOSTIC AND PROGNOSTIC BIOMARKERS. MICRORNAS ARE SINGLE-STRANDED NUCLEOTIDES ABLE TO REGULATE GENE EXPRESSION. THEY ARE A KEY COMPONENT OF THE EPIGENETIC MACHINERY, INVOLVED IN PHYSIOLOGICAL AND PATHOLOGICAL PROCESSES. THE CONTRIBUTION OF MICRORNAS IN AS AND PSA (SUCH AS MIR-29A IN REGULATING BONE METABOLISM) IS HIGHLIGHTED BY SEVERAL WORKS IN THE FIELD BUT THEIR UTILITY AS POSSIBLE MARKERS MUST BE STILL CONFIRMED, PARTICULARLY IN LARGER PATIENTS' COHORTS. 2021 8 555 33 AXIAL SPONDYLOARTHRITIS: RESHAPE THE FUTURE-FROM THE "2022 GISEA INTERNATIONAL SYMPOSIUM". THE TERM "AXIAL SPONDYLOARTHRITIS" (AXSPA) REFERS TO A GROUP OF CHRONIC RHEUMATIC DISEASES THAT PREDOMINANTLY INVOLVE THE AXIAL SKELETON AND CONSIST OF ANKYLOSING SPONDYLITIS, REACTIVE ARTHRITIS, ARTHRITIS/SPONDYLITIS ASSOCIATED WITH PSORIASIS (PSA) AND ARTHRITIS/SPONDYLITIS ASSOCIATED WITH INFLAMMATORY BOWEL DISEASES (IBD). MOREOVER, PAIN IS AN IMPORTANT AND COMMON SYMPTOM OF AXSPA. IT MAY PROGRESS TO CHRONIC PAIN, A MORE COMPLICATED BIO-PSYCHOSOCIAL PHENOMENA, LEADING TO A SIGNIFICANT WORSENING OF QUALITY OF LIFE. THE DEVELOPMENT OF THE AXSPA INFLAMMATORY PROCESS IS GROUNDED IN THE COMPLEX INTERACTION BETWEEN GENETIC (SUCH AS HLA B27), EPIGENETIC, AND ENVIRONMENTAL FACTORS ASSOCIATED WITH A DYSREGULATED IMMUNE RESPONSE. CONSIDERING THE PIVOTAL CONTRIBUTION OF IL-23 AND IL-17 IN AXSPA INFLAMMATION, THE INHIBITION OF THESE CYTOKINES HAS BEEN EVALUATED AS A POTENTIAL THERAPEUTIC STRATEGY. WITH THIS CONTEXT, HERE WE DISCUSS THE MAIN PATHOGENETIC MECHANISMS, THERAPEUTIC APPROACHES AND THE ROLE OF PAIN IN AXSPA FROM THE 2022 INTERNATIONAL GISEA/OEG SYMPOSIUM. 2022 9 6343 31 THE ROLE OF EPIGENETICS AND IMMUNOLOGICAL IMBALANCE IN THE ETIOPATHOGENESIS OF PSORIASIS AND PSORIATIC ARTHRITIS. PSORIASIS (PS) AND PSORIATIC ARTHRITIS (PSA) REPRESENT A CLINICAL AND IMMUNOPATHOGENIC CONTINUUM, CALLED PSORIATIC DISEASE, CUMULATIVELY AFFECTING APPROXIMATELY 3% OF THE GENERAL POPULATION. PSORIATIC DISEASE IS A CHRONIC INFLAMMATORY DISORDER AFFECTING THE SKIN AND MUSCULOSKELETAL SYSTEM. THE IMMUNO-PATHOGENESIS IS CHARACTERIZED BY AN ACTIVATION OF THE TNF/IL-23/IL-17 CYTOKINE AXIS, LEADING TO AN IMMUNOLOGIC IMBALANCE OF T-CELLS RESIDENT IN ALL AFFECTED TISSUES, MAINLY ENTHESES. IN THE MAJORITY OF CASES, SKIN PS PREDATES RHEUMATOLOGICAL MANIFESTATIONS. SECONDARY TO THE HIGHER INCIDENCE AND THE AVAILABILITY OF MOUSE MODELS, THERE IS STRONGER DATA AVAILABLE ON SKIN PS, AND DATA ARE, IN MOST CASES, RELEVANT ALSO TO PSA. IN A WIDELY ACCEPTED MODEL, ENVIRONMENTAL TRIGGER FACTORS LIKE INFECTIONS OR TRAUMA ARE CAPABLE OF INITIATING AN INFLAMMATORY CASCADE, ULTIMATELY CREATING A SUSTAINED STATE OF CHRONIC INFLAMMATION IN GENETICALLY SUSCEPTIBLE INDIVIDUALS. BESIDES WELL-KNOWN GENETIC SUSCEPTIBILITY LOCI, EPIGENETIC DNA MODIFICATIONS, WHICH ARE ASSOCIATED WITH PS DEVELOPMENT HAVE BEEN CHARACTERIZED RECENTLY AND WILL BE DISCUSSED IN THIS ARTICLE. THE CURRENT EVIDENCE IS PROMISING IN THE POSSIBILITY TO PROVIDE NEW THERAPEUTIC AVENUES AND FILL THE UNMET NEED OF PATIENTS, FOR WHOM CURRENT TREATMENTS EITHER DO NOT ALLOW THE DISEASE TO BE CONTROLLED OR MUST BE CONTINUED FOR LIFE. 2019 10 2726 30 EXPERIMENTAL PHARMACOLOGICAL MANAGEMENT OF PSORIASIS. PSORIASIS IS A CHRONIC, RELAPSING, IMMUNE-MEDIATED SYSTEMIC DISEASE. ITS PATHOGENESIS IS COMPLEX AND NOT FULLY UNDERSTOOD YET. GENETIC AND EPIGENETIC FACTORS INTERACT WITH MOLECULAR PATHWAYS INVOLVING TNF-ALPHA, IL-23/IL-17 AXIS, AND PECULIAR CYTOKINES, AS IL-36 OR PHOSPHODIESTERASE 4. THIS REVIEW DISCUSSES THE MECHANISMS INVOLVED IN THE DEVELOPMENT OF THE DISEASE, AS WELL AS THE THERAPEUTIC OPTIONS PROPOSED FOLLOWING THE INVESTIGATION OF THE INFLAMMATORY PSORIATIC PATHWAYS. WE PERFORMED A COMPREHENSIVE SEARCH USING THE WORDS "PSORIASIS" AND THE NEWEST MOLECULES CURRENTLY UNDER INVESTIGATION AND APPROVAL. FROM THESE DATA, A NEW SCENARIO IN PSORIASIS IS OCCURRING TO PERSONALIZE THE THERAPIES - ESPECIALLY SYSTEMIC ONES AND THOSE USING SMALL MOLECULES - AND AVOID TOPICAL AND INJECTABLE DRUGS. WE REPORTED THE NEWEST THERAPEUTIC OPPORTUNITIES, INCLUDING THE INHIBITORS OF JANUS KINASE/TYROSINE KINASE 2, PHOSPHODIESTERASE-4 AND IL-36 RECEPTOR. TODAY, MORE THAN 20 MOLECULES ARE UNDER INVESTIGATION FOR THE TREATMENT OF CUTANEOUS PSORIASIS. MOST OF THEM ARE CONSTITUTED BY SMALL MOLECULES OR BIOLOGIC THERAPIES. THIS UNDERLINES HOW PSORIASIS NEEDS SYSTEMIC THERAPIES, DUE TO ITS COMPLEX PATHOGENESIS AND MULTISYSTEMIC INVOLVEMENT. 2021 11 4756 36 NOVEL THERAPEUTIC TARGET(S) FOR PSORIATIC DISEASE. PSORIASIS AND PSORIATIC ARTHRITIS, TOGETHER KNOWN AS PSORIATIC DISEASE, IS HIGHLY PREVALENT CHRONIC RELAPSING INFLAMMATORY DISEASE AFFECTING SKIN, JOINTS OR BOTH AND IS ASSOCIATED WITH SEVERAL COMORBIDITIES SUCH AS CARDIOVASCULAR, METABOLIC, PSYCHIATRIC, RENAL DISEASE ETC. THE ETIOPATHOGENESIS OF PSORIASIS IS COMPLEX AND MAINLY DRIVEN BY ABERRANT IMMUNE RESPONSE OWING TO THE GENETIC SUSCEPTIBILITY AND VARIOUS ENVIRONMENTAL FACTORS SUCH AS TRAUMA, INFECTIONS AND DRUGS. RECENT ADVANCES IN UNDERSTANDING MOLECULAR AND CELLULAR PATHWAYS HAVE IDENTIFIED TUMOR NECROSIS FACTOR-ALPHA (TNF-ALPHA), INTERLEUKIN-17 (IL-17), IL-23, IL-22 AS MAJOR CONTRIBUTORS IN PSORIASIS PATHOGENESIS. ADVANCES IN THE KNOWLEDGE OF PATHOPHYSIOLOGY, THE INTERACTION OF AUTOINFLAMMATION AND CLINICAL PHENOTYPES HAVE LED TO THE DEVELOPMENT OF HIGHLY EFFECTIVE TARGETED THERAPEUTIC AGENTS WHICH INCLUDE TNF-ALPHA, IL-17, IL-23, IL-1 ALPHA/BETA OR IL-36 INHIBITORS OR RECEPTOR BLOCKERS, SMALL MOLECULE DRUGS LIKE PHOSPHODIESTERASE-4 INHIBITORS (APREMILAST), JANUS KINASE (JAK) INHIBITORS, RETINOIC ACID RECEPTOR-RELATED ORPHAN RECEPTOR GAMMAT (RORGAMMAT) INHIBITORS. THESE NOVEL DRUGS HAVE PROMISED THE POTENTIAL OF IMPROVED DISEASE CONTROL. IN RECENT YEARS, THE TRANSITION FROM BIOLOGICS TO BIOSIMILARS ESPECIALLY WITH TNF-ALPHA INHIBITORS HAD SIGNIFICANT IMPACT ON DECREASING HEALTH CARE COST AND INCREASING THERAPEUTIC OPTIONS TO THE PATIENTS. HOWEVER, SELECTION OF RIGHT TREATMENT FOR AN INDIVIDUAL PATIENT STILL REMAINS CHALLENGING. MOREOVER, INTERPLAY BETWEEN DIFFERENT EPIGENETIC MECHANISMS SUCH AS THE DNA METHYLATION, CHROMATIN MODIFICATIONS AND NONCODING RNA REGULATION HAS RECENTLY BEEN STARTED TO BE DECIPHERED. ENZYMES INHIBITORS INVOLVED IN EPIGENETIC PATHWAYS SUCH AS DNA METHYLTRANSFERASES AND HISTONE DEACETYLASES DEMONSTRATED TO RESTORE NORMAL EPIGENETIC PATTERNS IN CLINICAL SETTINGS AND HAVE PROVIDED THE POTENTIAL AS NOVEL THERAPEUTIC TARGETS FOR PSORIASIS. IN THIS REVIEW, WE WILL DISCUSS NOVEL BIOLOGIC AGENTS AND NEWER THERAPEUTIC APPROACHES IN TREATMENT OF PSORIATIC DISEASE. 2022 12 5036 36 PHARMACOGENETICS AND PHARMACOGENOMICS IN MODERATE-TO-SEVERE PSORIASIS. PHARMACOGENETICS IS THE STUDY OF VARIATIONS IN DNA SEQUENCE RELATED TO DRUG RESPONSE. MOREOVER, THE EVOLUTION OF BIOTECHNOLOGY AND THE SEQUENCING OF HUMAN DNA HAVE ALLOWED THE CREATION OF PHARMACOGENOMICS, A BRANCH OF GENETICS THAT ANALYZES HUMAN GENES, THE RNAS AND PROTEINS ENCODED BY THEM, AND THE INTER-AND INTRA-INDIVIDUAL VARIATIONS IN EXPRESSION AND FUNCTION IN RELATION TO DRUG RESPONSE. PHARMACOGENETICS AND PHARMACOGENOMICS ARE BEING USED TO SEARCH FOR BIOMARKERS THAT CAN PREDICT RESPONSE TO SYSTEMIC TREATMENTS, INCLUDING THOSE FOR MODERATE-TO-SEVERE PSORIASIS. PSORIASIS IS A CHRONIC INFLAMMATORY DISEASE WITH AN AUTOIMMUNE CONTRIBUTION. ALTHOUGH ITS ETIOLOGY REMAINS UNKNOWN, GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS PLAY A ROLE IN ITS DEVELOPMENT. DIVERSE SYSTEMIC AND BIOLOGIC THERAPIES ARE USED TO TREAT MODERATE-TO-SEVERE PSORIASIS. HOWEVER, THESE TREATMENTS ARE NOT CURATIVE, AND PATIENTS EXHIBIT A WIDE RANGE OF RESPONSES TO THEM. MODERATE-TO-SEVERE PSORIASIS IS USUALLY TREATED WITH SYSTEMIC IMMUNOMODULATORS SUCH AS ACITRETIN, CICLOSPORIN, AND METHOTREXATE. ANTI-TUMOR NECROSIS FACTOR (TNF) DRUGS (ADALIMUMAB, ETANERCEPT, OR INFLIXIMAB) ARE THE FIRST-LINE TREATMENT FOR PATIENTS RESISTANT TO CONVENTIONAL SYSTEMIC THERAPIES. ALTHOUGH THESE THERAPIES ARE VERY EFFICIENT, AROUND 30-50% OF PATIENTS HAVE INADEQUATE RESPONSE. USTEKINUMAB IS A MONOCLONAL ANTIBODY THAT TARGETS INTERLEUKIN (IL)-12 AND IL-23 AND IS USED FOR MODERATE-TO-SEVERE PSORIASIS. NEW DRUGS (APREMILAST, BRODALUMAB, GUSELKUMAB, IXEKIZUMAB, AND SECUKINUMAB) HAVE RECENTLY BEEN APPROVED FOR PSORIASIS. HOWEVER, RESPONSE RATES TO SYSTEMIC TREATMENTS FOR MODERATE-TO-SEVERE PSORIASIS RANGE FROM 35 TO 80%, SO IT IS NECESSARY TO IDENTIFY NON-INVASIVE BIOMARKERS THAT COULD HELP PREDICT TREATMENT OUTCOMES OF THESE THERAPIES AND INDIVIDUALIZE CARE FOR PATIENTS WITH PSORIASIS. THESE BIOMARKERS COULD IMPROVE PATIENT QUALITY OF LIFE AND REDUCE HEALTH COSTS AND POTENTIAL SIDE EFFECTS. PHARMACOGENETIC STUDIES HAVE IDENTIFIED POTENTIAL BIOMARKERS FOR RESPONSE TO BIOLOGIC TREATMENTS FOR MODERATE-TO-SEVERE PSORIASIS. THESE BIOMARKERS NEED TO BE VALIDATED IN CLINICAL TRIALS INVOLVING LARGE COHORTS OF PATIENTS BEFORE THEY CAN BE TRANSLATED TO THE CLINIC. WE REVIEW PHARMACOGENETICS AND PHARMACOGENOMICS STUDIES FOR THE TREATMENT OF MODERATE-TO-SEVERE PLAQUE PSORIASIS. 2018 13 5308 30 PSORIASIS AND PHYSICAL ACTIVITY: A REVIEW. PSORIASIS IS A COMMON, CHRONIC INFLAMMATORY SKIN DISEASE THAT CAN CAUSE SIGNIFICANT DISCOMFORT AND IMPAIRMENT TO QUALITY OF LIFE. RECENT RESEARCH INDICATES THAT INDIVIDUALS WITH MODERATE-TO-SEVERE PSORIASIS ARE LIKELY AT GREATER RISK FOR CHRONIC CARDIOMETABOLIC CO-MORBIDITIES SUCH AS CARDIOVASCULAR DISEASE, TYPE 2 DIABETES, OBESITY AND METABOLIC SYNDROME. PHYSICAL ACTIVITY CAN BE AN EFFECTIVE PRIMARY AND ADJUNCTIVE TREATMENT FOR THESE MALADIES IN OTHER POPULATIONS. UNFORTUNATELY, ONLY A LIMITED NUMBER OF STUDIES HAVE EXAMINED PHYSICAL ACTIVITY IN PSORIASIS, WHICH ARE LIMITED BY POOR DESIGN AND LACK OF VALIDATED PHYSICAL ACTIVITY ASSESSMENT METHODOLOGIES. A VARIETY OF DATA SUGGEST SHARED PHYSIOLOGIC PATHWAYS BETWEEN PHYSICAL ACTIVITY, PSORIASIS, AND PSORIASIS CARDIOMETABOLIC CO-MORBIDITIES. INCREASED ADIPOSITY, INFLAMMATION, OXIDATIVE STRESS, ADHESION MOLECULES AND LIPIDS ARE PHYSIOLOGICALLY LINKED TO PSORIASIS, THE RISK OF PSORIASIS CARDIOMETABOLIC CO-MORBIDITIES, AND LOW LEVELS OF PHYSICAL ACTIVITY. IN ADDITION, EPIGENETIC PATHWAYS ARE INVOLVED IN PSORIASIS AND COULD BE INFLUENCED BY PHYSICAL ACTIVITY. THE PHYSICAL AND PSYCHOSOCIAL IMPAIRMENTS COMMON IN PSORIASIS MAY MAKE IT DIFFICULT TO PARTICIPATE IN REGULAR PHYSICAL ACTIVITY, AND FUTURE STUDIES SHOULD AIM TO DETERMINE IF PHYSICAL ACTIVITY INTERVENTIONS IMPROVE FUNCTIONING AND REDUCE CO-MORBIDITIES IN PSORIASIS. 2012 14 367 31 AMPLIFIED PAIN SYNDROMES IN CHILDREN: TREATMENT AND NEW INSIGHTS INTO DISEASE PATHOGENESIS. PURPOSE OF REVIEW: ALTHOUGH MANY DIAGNOSTIC TERMS ARE USED FOR PEDIATRIC CHRONIC PAIN, EVIDENCE SUGGESTS A COMMON THREAD OF SIGNAL AMPLIFICATION, LEADING TO THE UNIFYING TERM 'AMPLIFIED PAIN SYNDROMES'. ONGOING RESEARCH PROVIDES NEW INSIGHTS INTO BIOPSYCHOSOCIAL CONTRIBUTORS AND TREATMENTS FOR PEDIATRIC AMPLIFIED PAIN SYNDROMES. RECENT FINDINGS: BASIC SCIENCE INDICATES A COMPLEX INTERPLAY OF GENETIC, EPIGENETIC, NEUROCHEMICAL, ENDOCRINE, AND INFLAMMATORY CONTRIBUTORS, ALONG WITH ENVIRONMENTAL AND PSYCHOLOGICAL FACTORS. ALTHOUGH MEDICATIONS AND INTERVENTIONS REMAIN COMMON APPROACHES TO CHILDREN WITH CHRONIC PAIN, THEIR EVIDENCE IS LIMITED. PRELIMINARY EVIDENCE EXISTS FOR MINDFULNESS-BASED THERAPIES, YOGA, AND OTHER COMPLEMENTARY/ALTERNATIVE MEDICINE APPROACHES. THE STRONGEST EVIDENCE IS FOR EXERCISE-BASED AND COGNITIVE-BEHAVIORAL TREATMENTS, IN PARTICULAR, WHEN COMBINED IN A MULTIDISCIPLINARY FORMAT. INTENSIVE APPROACHES (PAIN REHABILITATION) HAVE THE POTENTIAL TO EFFECTIVELY AND EFFICIENTLY TREAT THOSE MOST DISABLED BY AMPLIFIED PAIN SYNDROMES, AND LEAD TO SUSTAINED IMPROVEMENT IN PAIN, FUNCTIONING, AND MEDICAL UTILIZATION. SUMMARY: ALTHOUGH UNDERSTANDING OF THE MECHANISMS UNDERLYING PEDIATRIC AMPLIFIED PAIN SYNDROMES EVOLVES, STANDARD OF CARE IS MULTIDISCIPLINARY EMPHASIZING EXERCISE THERAPY, COGNITIVE-BEHAVIORAL TREATMENT, AND SELF-REGULATION. TREATMENT SHOULD TARGET FULL RETURN TO PHYSICAL FUNCTION, WHICH LEADS TO SUBSEQUENT IMPROVEMENT OR RESOLUTION OF PAIN. MULTIDISCIPLINARY CARE CAN BE COORDINATED BY A RHEUMATOLOGIST OR OTHER PHYSICIAN WITH APPROPRIATE REFERRALS, OR THROUGH A MULTIDISCIPLINARY TEAM. 2014 15 2063 22 EPIGENETIC CONTROL OF IL-23 EXPRESSION IN KERATINOCYTES IS IMPORTANT FOR CHRONIC SKIN INFLAMMATION. THE CHRONIC SKIN INFLAMMATION PSORIASIS IS CRUCIALLY DEPENDENT ON THE IL-23/IL-17 CYTOKINE AXIS. ALTHOUGH IL-23 IS EXPRESSED BY PSORIATIC KERATINOCYTES AND IMMUNE CELLS, ONLY THE IMMUNE CELL-DERIVED IL-23 IS BELIEVED TO BE DISEASE RELEVANT. HERE WE USE A GENETIC MOUSE MODEL TO SHOW THAT KERATINOCYTE-PRODUCED IL-23 IS SUFFICIENT TO CAUSE A CHRONIC SKIN INFLAMMATION WITH AN IL-17 PROFILE. FURTHERMORE, WE REVEAL A CELL-AUTONOMOUS NUCLEAR FUNCTION FOR THE ACTIN POLYMERIZING MOLECULE N-WASP, WHICH CONTROLS IL-23 EXPRESSION IN KERATINOCYTES BY REGULATING THE DEGRADATION OF THE HISTONE METHYLTRANSFERASES G9A AND GLP, AND H3K9 DIMETHYLATION OF THE IL-23 PROMOTER. THIS MECHANISM MEDIATES THE INDUCTION OF IL-23 BY TNF, A KNOWN INDUCER OF IL-23 IN PSORIASIS. FINALLY, IN KERATINOCYTES OF PSORIATIC LESIONS A DECREASE IN H3K9 DIMETHYLATION CORRELATES WITH INCREASED IL-23 EXPRESSION, SUGGESTING RELEVANCE FOR DISEASE. TAKEN TOGETHER, OUR DATA DESCRIBE A MOLECULAR PATHWAY WHERE EPIGENETIC REGULATION OF KERATINOCYTES CAN CONTRIBUTE TO CHRONIC SKIN INFLAMMATION. 2018 16 4883 30 OVERVIEW OF THE MOLECULAR DETERMINANTS CONTRIBUTING TO THE EXPRESSION OF PSORIASIS AND PSORIATIC ARTHRITIS PHENOTYPES. PSORIASIS AND PSORIATIC ARTHRITIS ARE MULTIFACTORIAL CHRONIC DISORDERS WHOSE ETIOPATHOGENESIS ESSENTIALLY DERIVES FROM THE ALTERATION OF SEVERAL SIGNALLING PATHWAYS AND THE CO-OCCURRENCE OF GENETIC, EPIGENETIC AND NON-GENETIC SUSCEPTIBILITY FACTORS THAT ALTOGETHER AFFECT THE FUNCTIONAL AND STRUCTURAL PROPERTY OF THE SKIN. ALTHOUGH SHARED AND DIFFERENTIAL SUSCEPTIBILITY GENES AND MOLECULAR PATHWAYS ARE KNOWN TO CONTRIBUTE TO THE ONSET OF PATHOLOGICAL PHENOTYPES, FURTHER RESEARCH IS NEEDED TO DISSECT THE MOLECULAR CAUSES OF PSORIATIC DISEASE AND ITS PROGRESSION TOWARDS PSORIATIC ARTHRITIS. THIS REVIEW WILL THEREFORE BE ADDRESSED TO EXPLORE DIFFERENCES AND SIMILARITIES IN THE ETIOPATHOGENESIS AND PROGRESSION OF BOTH DISORDERS, WITH A PARTICULAR FOCUS ON GENES INVOLVED IN THE MAINTENANCE OF THE SKIN STRUCTURE AND INTEGRITY (KERATINS AND COLLAGENS), MODULATION OF PATTERNS OF RECOGNITION (THROUGH TOLL-LIKE RECEPTORS AND DECTIN-1) AND IMMUNO-INFLAMMATORY RESPONSE (BY NLRP3-DEPENDENT INFLAMMASOME) TO MICROBIAL PATHOGENS. IN ADDITION, SPECIAL EMPHASIS WILL BE GIVEN TO THE CONTRIBUTION OF EPIGENETIC ELEMENTS (METHYLATION PATTERN, NON-CODING RNAS, CHROMATIN MODIFIERS AND 3D GENOME ORGANIZATION) TO THE ETIOPATHOGENESIS AND PROGRESSION OF PSORIASIS AND PSORIATIC ARTHRITIS. THE EVIDENCE DISCUSSED IN THIS REVIEW HIGHLIGHTS HOW THE KNOWLEDGE OF PATIENTS' CLINICAL AND (EPI)GENOMIC MAKE-UP COULD BE HELPFUL FOR IMPROVING THE AVAILABLE THERAPEUTIC STRATEGIES FOR PSORIASIS AND PSORIATIC ARTHRITIS TREATMENT. 2020 17 5039 27 PHARMACOGENETICS OF CHRONIC PAIN MANAGEMENT. OBJECTIVE: THE EXPERIENCE OF CHRONIC PAIN IS ONE OF THE COMMONEST REASONS INDIVIDUALS SEEK MEDICAL ATTENTION, MAKING THE MANAGEMENT OF CHRONIC PAIN A MAJOR ISSUE IN CLINICAL PRACTICE. DRUG METABOLISM AND RESPONSES ARE AFFECTED BY MANY FACTORS, WITH GENETIC VARIATIONS OFFERING ONLY A PARTIAL EXPLANATION OF AN INDIVIDUAL'S RESPONSE. THERE IS A PAUCITY OF EVIDENCE FOR THE BENEFITS OF PHARMACOGENETIC TESTING IN THE CONTEXT OF PAIN MANAGEMENT. DESIGN AND METHODS: WE REVIEWED THE LITERATURE BETWEEN 2000 AND 2013, AND REFERENCES CITED THEREIN, USING VARIOUS KEYWORDS RELATED TO PAIN MANAGEMENT, PHARMACOLOGY AND PHARMACOGENETICS. RESULTS: OPIOIDS CONTINUE TO BE THE MAINSTAY OF CHRONIC PAIN MANAGEMENT. SEVERAL NON-OPIOID BASED THERAPIES, SUCH AS TREATMENT WITH CANNABINOIDS, GENE THERAPY AND EPIGENETIC-BASED APPROACHES ARE NOW AVAILABLE FOR THESE PATIENTS. ADJUVANT THERAPIES WITH ANTIDEPRESSANTS, BENZODIAZEPINES OR ANTICONVULSANTS CAN ALSO BE USEFUL IN MANAGING PAIN. CURRENTLY, LABORATORY MONITORING OF PAIN MANAGEMENT PATIENTS, IF PERFORMED, IS LARGELY THROUGH URINE DRUG MEASUREMENTS. CONCLUSIONS: DRUG HALF-LIFE CALCULATIONS CAN BE USED AS FUNCTIONAL MARKERS OF THE CUMULATIVE EFFECT OF PHARMACOGENETICS AND DRUG-DRUG INTERACTIONS. ASSESSMENT OF HALF-LIFE AND THERAPEUTIC EFFECTS MAY BE MORE USEFUL THAN GENETIC TESTING IN PREVENTING ADVERSE DRUG REACTIONS TO PAIN MEDICATIONS, WHILE ENSURING EFFECTIVE ANALGESIA. DEFINITIVE, MASS SPECTROMETRY-BASED METHODS, CAPABLE OF MEASURING PARENT DRUG AND METABOLITE LEVELS, ARE THE MOST USEFUL ASSAYS FOR THIS PURPOSE. URINE DRUG MEASUREMENTS DO NOT NECESSARILY CORRELATE WITH SERUM DRUG CONCENTRATIONS OR THERAPEUTIC EFFECTS. THEREFORE, THEY ARE LIMITED IN THEIR USE IN MONITORING EFFICACY AND TOXICITY. 2014 18 3033 42 GENETICS, EPIGENETICS, AND GENDER IMPACT IN AXIAL-SPONDYLOARTHRITIS SUSCEPTIBILITY: AN UPDATE ON GENETIC POLYMORPHISMS AND THEIR SEX RELATED ASSOCIATIONS. SPONDYLOARTHRITIS (SPA) IS A GROUP OF CHRONIC INFLAMMATORY RHEUMATIC DISEASE THAT CAN BE DIVIDED INTO PREDOMINANTLY AXIAL OR PREDOMINANTLY PERIPHERAL INVOLVEMENT, WITH OR WITHOUT ASSOCIATED PSORIASIS, INFLAMMATORY BOWEL DISEASE OR PREVIOUS INFECTION. AXIAL SPA (AXSPA) ENCOMPASSES ANKYLOSING SPONDYLITIS (AS) WITH RADIOLOGICAL SACROILIITIS, AND A TYPE WITHOUT RADIOGRAPHIC SACROILIITIS, CALLED "NON-RADIOGRAPHIC AXIAL SPA" (NR-AXSPA). MALES AND FEMALES SHOW LARGE DIFFERENCES IN THEIR SUSCEPTIBILITY TO SPA, SUCH AS DISTINCTIONS IN CLINICAL PATTERNS, PHENOTYPES AND IN THERAPEUTICAL RESPONSE, PARTICULARLY TO TNF INHIBITORS (TNFI). SEVERAL STUDIES INDICATE THAT AS WOMEN HAVE DOUBLED RISK TO FAILURE TNFI COMPARED WITH MALES. THIS DIVERSITY IN DRUGS' EFFICACY AMONG WOMEN AND MEN MAY BE CAUSED BY DIFFERENCES IN THE BALANCE OF SEX HORMONES AND IN GENE-SPECIFIC EXPRESSION LIKELY TRIGGERED BY X-CHROMOSOME INSTABILITY AND GENE-SPECIFIC EPIGENETIC MODIFICATIONS. EVIDENCE REPORTED THAT POLYMORPHISMS IN MICRORNAS ON X- AND OTHER CHROMOSOMES, SUCH AS MIR-146A, MIR-155, MIR-125A-5P, MIR-151A-3P AND MIR-22-3P, MIR-199A-5P COULD BE INVOLVED IN THE DIFFERENT CLINICAL PRESENTATION OF SPA, AS WELL AS DISEASE ACTIVITY. IN ADDITION, ASSOCIATION WITH NON-RESPONSE TO TNFI TREATMENT AND PRESENCE OF IRAK3 AND CHUCK GENES IN SPA PATIENTS WAS RECENTLY DETECTED. FINALLY, POLYMORPHISMS IN GENES INVOLVED IN IL-23/IL-17 PATHWAY, SUCH AS IN DRUG PHARMACODYNAMICS AND PHARMACOKINETICS MAY HAVE A ROLE IN RESPONSE TO TNFI, IL17I, AND IL23I. A MAJOR UNDERSTANDING OF GENOMIC VARIABILITY COULD HELP IN THE DEVELOPMENT OF NEW THERAPEUTIC TARGETS OR IN TAKING ADVANTAGES OF DIFFERENT MECHANISMS OF ACTION OF BIOLOGICAL DRUGS. MOVING FROM THE MULTIFACTORIAL ETIOLOGY OF DISEASE, THE PRESENT REVIEW AIMS AT EVALUATING GENETIC AND EPIGENETIC FACTORS AND THEIR RELATIONSHIP WITH SEX AND BDMARDS RESPONSE, HELPING TO INVESTIGATE THE DIFFERENT EXPRESSION AMONG MALES AND FEMALES OF GENES ON X- AND OTHER CHROMOSOMES, AS WELL AS MI-RNA, TO HIGHLIGHT RELATIONSHIPS BETWEEN SEX AND OCCURRENCE OF SPECIFIC PHENOTYPES AND SYMPTOMS OF THE DISEASE. MOREOVER, THE ROLE OF THE EPIGENETIC MODIFICATION IN RELATION TO IMMUNE-REGULATORY MECHANISMS WILL BE EVALUATED. 2021 19 852 33 CHOLANGIOCARCINOMA IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS (PSC): A COMPREHENSIVE REVIEW. CHOLANGIOCARCINOMA (CCA) IS THE MOST COMMON MALIGNANCY IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS (PSC) AND CARRIES A HIGH RATE OF MORTALITY. ALTHOUGH THE PATHOGENESIS OF CCA IN PSC IS LARGELY UNKNOWN, INFLAMMATION-DRIVEN CARCINOGENESIS CONCOMITANT WITH VARIOUS GENETIC AND EPIGENETIC ABNORMALITIES ARE UNDERLYING FACTORS. THE MAJORITY OF CCA CASES DEVELOP FROM A DOMINANT STRICTURE (DS), WHICH IS DEFINED AS A STRICTURE WITH A DIAMETER < 1.5 MM IN THE COMMON BILE DUCT OR < 1.0 MM IN THE HEPATIC DUCT. IN PSC PATIENTS PRESENTING WITH AN ABRUPT AGGRAVATION OF JAUNDICE, PAIN, FATIGUE, PRURITUS, WEIGHT LOSS, OR WORSENING LIVER BIOCHEMISTRIES, CCA SHOULD BE SUSPECTED AND EVALUATED UTILIZING A VARIETY OF DIAGNOSTIC MODALITIES. HOWEVER, EARLY RECOGNITION OF CCA IN PSC REMAINS A MAJOR CHALLENGE. IMPORTANTLY, 30-50% OF CCA IN PSC PATIENTS ARE OBSERVED WITHIN THE FIRST YEAR FOLLOWING THE DIAGNOSIS OF PSC FOLLOWED BY AN ANNUAL INCIDENCE RANGING FROM 0.5 TO 1.5 PER 100 PERSONS, WHICH IS NEARLY 10 TO 1000 TIMES HIGHER THAN THAT IN THE GENERAL POPULATION. CUMULATIVE 5-YEAR, 10-YEAR, AND LIFETIME INCIDENCES ARE 7%, 8-11%, AND 9-20%, RESPECTIVELY. WHEN PSC-ASSOCIATED CCA IS DIAGNOSED, MOST TUMORS ARE UNRESECTABLE, AND NO EFFECTIVE MEDICATIONS ARE AVAILABLE. GIVEN THE POOR THERAPEUTIC OUTCOME, THE SURVEILLANCE AND MANAGEMENT OF PSC PATIENTS WHO ARE AT AN INCREASED RISK OF DEVELOPING CCA ARE OF IMPORTANCE. SUCH PATIENTS INCLUDE OLDER MALES WITH LARGE-DUCT PSC AND POSSIBLY CONCURRENT ULCERATIVE COLITIS. THUS, MORE ATTENTION SHOULD BE PAID TO PATIENTS WITH THESE CLINICAL FEATURES, IN PARTICULAR WITHIN THE FIRST YEAR AFTER PSC DIAGNOSIS. IN CONTRAST, CCA IS LESS FREQUENTLY OBSERVED IN PEDIATRIC OR FEMALE PSC PATIENTS OR IN THOSE WITH SMALL-DUCT PSC OR CONCURRENT CROHN'S DISEASE. RECENTLY, NEW BIOMARKERS SUCH AS ANTIBODIES TO GLYCOPROTEIN 2 HAVE BEEN FOUND TO BE ASSOCIATED WITH AN INCREASED RISK OF DEVELOPING CCA IN PSC. HEREIN, WE REVIEW THE LITERATURE ON THE PATHOGENESIS, INCIDENCE, CLINICAL FEATURES, AND RISK FACTORS, WITH A FOCUS ON VARIOUS DIAGNOSTIC MODALITIES OF PSC-ASSOCIATED CCA. 2020 20 1160 16 CONTINUING WAR ON PAIN: A PERSONALIZED APPROACH TO THE THERAPY WITH NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS. SUCCESSFUL PAIN MANAGEMENT REQUIRES THE DELIVERY OF ANALGESIA WITH MINIMAL RISK OF ADVERSE DRUG REACTIONS. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS REMAIN THE MAINSTAY OF TREATMENT FOR THE MAJORITY OF PATIENTS. UNFORTUNATELY, ALMOST 50% OF ALL PATIENTS EXPERIENCE INADEQUATE PAIN RELIEF AND SERIOUS SIDE EFFECTS. ALLELIC VARIANTS IN GENES CODING FOR TARGET PROTEINS, TRANSPORTERS AND ENZYMES, WHICH GOVERN ANALGESIC DRUGS ACTION AND THEIR FATE IN THE ORGANISM, MIGHT EXPLAIN INTER-INDIVIDUAL VARIABILITY IN PAIN SEVERITY AND IN DRUG-INDUCED PAIN RELIEF AND TOXICITIES. ADDITIONALLY, IT SEEMS THAT EPIGENETIC CHANGES CONTRIBUTE TO THE HIGHLY VARIABLE RESPONSE TO PAIN TREATMENT. THEREFORE, PHARMACOGENOMIC TESTING MIGHT BE A VALUABLE TOOL FOR PERSONALIZATION OF PAIN TREATMENT, WITH A MULTIDISCIPLINARY TEAM APPROACH INVOLVED. 2019