Skin Sodium Accumulates in Psoriasis and Reflects Disease Severity

Maifeld A, Wild J, Karlsen TV, Rakova N, Wistorf E, Linz P, Jung R, Birukov A, Gimenez-Rivera VA, Wilck N, Bartolomaeus T, Dechend R, Kleinewietfeld M, Forslund SK, Krause A, Kokolakis G, Philipp S, Clausen BE, Brand A, Waisman A, Kurschus FC, Wegner J, Schultheis M, Luft FC, Boschmann M, Kelm M, Wiig H, Kuehne T, Müller DN, Karbach S, Markó L (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Journal of Investigative Dermatology Elsevier

DOI: 10.1016/j.jid.2021.06.013

Abstract

Sodium can accumulate in the skin at concentrations exceeding serum levels. A high sodium environment can lead to pathogenic T helper 17 cell expansion. Psoriasis is a chronic inflammatory skin disease in which IL-17‒producing T helper 17 cells play a crucial role. In an observational study, we measured skin sodium content in patients with psoriasis and in age-matched healthy controls by Sodium-23 magnetic resonance imaging. Patients with PASI > 5 showed significantly higher sodium and water content in the skin but not in other tissues than those with lower PASI or healthy controls. Skin sodium concentrations measured by Sodium-23 spectroscopy or by atomic absorption spectrometry in ashed-skin biopsies verified the findings with Sodium-23 magnetic resonance imaging. In vitro T helper 17 cell differentiation of naive CD4+ cells from patients with psoriasis markedly induced IL-17A expression under increased sodium chloride concentrations. The imiquimod-induced psoriasis mouse model replicated the human findings. Extracellular tracer Chromium-51–EDTA measurements in imiquimod- and sham-treated skin showed similar extracellular volumes, rendering excessive water of intracellular origin. Chronic genetic IL-17A‒driven psoriasis mouse models underlined the role of IL-17A in dermal sodium accumulation and inflammation. Our data describe skin sodium as a pathophysiological feature of psoriasis, which could open new avenues for its treatment.

Authors with CRIS profile

Peter Linz Institute of Radiology

Involved external institutions

Universitätsmedizin der Johannes Gutenberg-Universität Mainz DE Germany (DE) Max-Delbrück-Centrum für Molekulare Medizin / Max Delbrück Center for Molecular Medicine (MDC) Berlin-Buch DE Germany (DE) University of Bergen / Universitetet i Bergen NO Norway (NO) Universitätsklinikum Heidelberg DE Germany (DE) Hasselt University / Universiteit Hasselt BE Belgium (BE) Berliner Institut für Gesundheitsforschung (BIH) DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH DE Germany (DE)

How to cite

APA:

Maifeld, A., Wild, J., Karlsen, T.V., Rakova, N., Wistorf, E., Linz, P.,... Markó, L. (2021). Skin Sodium Accumulates in Psoriasis and Reflects Disease Severity. Journal of Investigative Dermatology. https://doi.org/10.1016/j.jid.2021.06.013

MLA:

Maifeld, András, et al. "Skin Sodium Accumulates in Psoriasis and Reflects Disease Severity." Journal of Investigative Dermatology (2021).

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