Levels of endothelial cell stimulating angiogenesis factor and vascular endothelial growth factor are elevated in psoriasis

Neovascularization appears to play an early and important part in the evolu tion of psoriatic plaques. We studied the distribution and production of tw o known angiogenesis factors, endothelial cell stimulating angiogenesis fac tor (ESAF) and vascular endothelial growth factor (VEGF), in the skin of pa tients with chronic plaque psoriasis and normal control subjects. Our resul ts showed that tissue levels of ESAF and VEGF were significantly elevated i n involved as compared with normal control skin (P = 0.006 and P < 0.0001, respectively), Tissue levels of ESAF and VEGF were also raised in involved skin as compared with uninvolved skin in patients with psoriasis (P = 0.001 and P < 0.0001, respectively). Tissue levels of ESAF and VEGF in plaques o f psoriasis correlated closely with the clinical severity of psoriasis (I = 0.6 and r = 0.9, respectively). Serum levels of ESAF and VEGF were signifi cantly raised in patients with psoriasis as compared with control subjects (P = 0.001 and P = 0.02, respectively). In vitro culture studies revealed t hat ESAF is produced by both keratinocytes and fibroblasts in approximately equal quantities in normal skin, whereas VEGF is secreted predominately by keratinocytes. A similar pattern is seen in both involved and uninvolved s kin of patients with psoriasis. However, there is increased secretion of bo th factors in keratinocytes and fibroblasts from involved and uninvolved sk in as compared with normal control skin (P < 0.001). The increased levels a nd secretion in plaques of psoriasis of two molecules, ESAF and VEGF, known to promote new blood vessel formation, suggest a pathogenetic role for the m in this disease.