الفهرس 
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Abstract
Psoriasis is a systemic inflammatory disease with a complex multifactorial pathogenesis. Recently, a considerable interest has been focused on interaction between gut microbiome, intestinal barrier and immune system. The so-called ‘gut-skin axis’ has been considered as a key factor in the etiology of psoriasis and, hence, a potential therapeutic target. Patients with psoriasis were suggested to have a state of an altered gut microbiome composition (dysbiosis) and different structural aberrations of the intestinal barrier structure. Intestinal microbiome continuously interacts with enterocytes in an effort to control systemic release of metabolites through a healthy intestinal barrier. Physiological colonization of the gastrointestinal tract promotes intestinal barrier formation, whereas dysbiosis and other factors can disrupt this barrier with increased gut permeability. In turn, translocation of bacteria, microbial toxins and metabolites into the peripheral circulation results in immune activation and development of many related illnesses, including psoriasis. The aim of our study was to assess two non-invasive markers of intestinal barrier integrity in patients with psoriasis in order to investigate the concept of gut-skin axis integrity. Concentrations of CLDN3 (a marker of intestinal epithelial tight junction structure) and I-FABP (marker of enterocyte damage) were evaluated using ELISA. Also, their possible relations with different demographic, clinical and laboratory findings were explored in psoriatic patients. This is a case-control hospital-based study which was carried out in Dermatology, Venereology and Andrology Department in collaboration with the Clinical Pathology Department, Assiut University Hospitals, Assiut, Egypt, from October 2020 to May 2021. This study included 50 patients with different clinical types of psoriasis. Patients included 29 (58.0%) males and 21 (42.0%) females. Their age ranged from (18-80) years with a mean age of 45.26±15. Also, 35 age and sex-matched healthy volunteers were included in this study as controls. The number of rural patients was 35 (70%) and urban patients was 15 (30%). The range of body mass index (BMI) in the patients’ group was (20-44.80) with a mean±SD of 28.41±6.07. Family history of psoriasis was positive in 15 patients (30%). Course was described to be progressive by 68% of patients. Lesional pruritus was reported by 94% of our patients. Regarding skin phototype, we found that 21 patients (42%) have skin type III and 29 patients (58%) have skin type IV. Regarding triggering factors, stress was the main triggering factor of psoriasis in 28 patients (56%), change of season in 27 patients (54%), trauma (Koebner phenomenon) in 24 patients (48%) and smoking in only 1 patient (2%).Regarding clinical types, plague psoriasis was present in 45 patients (90%) and erythrodermic psoriasis in 2 patients (4%). However, guttate; pustular and inverse psoriasis were in seen in 1 patient (2%), each. Nail affection was detected in 27 patients (54%). While, scalp affection was seen in 23 patients (46%). The PASI score ranged between (0.3-64) with a mean±SD of 10.75±11.34. We could not detect any significant statistical difference in laboratory investigations (CBC, blood urea, serum creatinine, AST, ALT and RBS) between patients and controls. We found that CLDN3 concentrations were significantly higher in patients with psoriasis when compared with healthy controls (p= 0.002). Also, concentrations of plasma I-FABP were found to be significantly higher in patients (p= 0.04). There was no significant statistical difference between the serum levels of CLDN3 and I-FABP in patients from urban and rural areas. We found that gender did not have any significant impact on the serum levels of CLDN3 and I-FABP in psoriatic patients. Unexpectedly, the clinical type and severity did not have any significant influence on the serum levels of CLDN3 and I-FABP in patients. There was no significant statistical difference between the serum levels of CLDN3 and I-FABP in patients with or without family history of psoriasis. Interestingly, we were able to detect a significant statistical difference between the mean serum level of I-FABP in patients with skin phototypes III and IV (p = 0.04). However, we could not detect such a difference with CLDN3 There was a highly significant positive statistical correlation between serum levels of CLDN3 and I-FABP (p =< 0.001). Also, there was a significant positive statistical correlation between I-FABP and age (p = 0.025). Similarly, a positive correlation was noticed between I-FABP and disease duration (p = 0.036). Otherwise, we could not detect any significant relation between either CLDN3 or I-FABP with any other clinical or laboratory variable in patients. Our results support the hypothesis of the impaired gut-skin axis integrity as an etiopathogenic factor in psoriatic patients. from the results of this study, we can conclude that: Psoriasis is slightly more common in males. Psoriasis has a wide range in terms of age of onset, disease duration and severity. Family history of psoriasis is positive in around one third of patients. Psoriasis patients are usually of darker skin phototypes. However, this can be a reflection of the usual phototypes of our locality. Pruritus is reported in almost all psoriasis patients. Psoriatic patients are obese. However, this could be a reflection of obesity prevalence in our general population. Stress is the most common triggering factor of psoriasis. Plaque psoriasis was the most common type in our patients. Nail and scalp affections were reported in almost half of the patients. Routine laboratory investigations were similar in our patients and controls. Levels of CLDN3 and I-FABP, as non-invasive markers of intestinal barrier integrity, were significantly higher in patients.
• Gender, residence, family history, clinical type, severity and laboratory markers did not have any significant impact on the levels of CLDN3 and I-FABP. However, I-FABP levels are probably related to disease chronic.