Here, we use DIA-MS to evaluate proteomic differences in psoriatic lesions between sPV and mPV and simultaneously determine some biomarkers associated with disease severity. We quantified 6418 proteins in the DIA-MS test, which was significantly higher than that in a previous proteomic study using LC-MS/MS17,18 or the Tandem Mass Tags (TMT) approach19. These results show that DIA-MS has significantly advanced global protein quantification across multiple samples. Our research identified 173 DEPs in the sPV group compared to the mPV group, which likely plays a crucial role in psoriasis and were associated with disease severity. The main active pathways were antimicrobial peptides and PTEN signalling, while the inhibitory pathways were the neutrophil extracellular trap pathway, neutrophil degranulation, and IL-8 signalling.
BP enrichment included several proteins that participate in the defence response to the bacterium, such as defence response to Gram-negative bacterium, antimicrobial humoral immune response mediated by AMP, antibacterial humoral response and response to Lipopolysaccharide. These proteins include AMPs, serine protease, chaperone protein, co-receptor and other molecules. Our work confirms the initial role of bacterial origin elements in psoriasis and the excessive innate immune responses induced by them4. Given the initial role of trauma and infection in the onset of psoriasis, it is essential to strengthen skin care, such as enhanced emollients, and to prevent local infections, especially in the progression of psoriasis. Patients should be educated to avoid washing skin lesions with salt or hot water (Especially among the Chinese) to avoid aggravating them.
Consistent with previous studies, KEGG enrichment and IPA analysis found that few DEPs predominantly participated in the IL − 17 signalling pathway and NF − kappa B signalling pathway, which plays a vital role in the pathogenesis of psoriasis20. In addition to being regulated by upstream regulators, interactions network by STRING found these molecules interacting with each other or chaperone proteins (mainly HSP90AA1) and then regulating specific target proteins involved in cell cycle control and signal transduction or the transcription machinery. All of this indicated the diversity and complexity of the functions of these molecules.
S100A7 (Psoriasin) is one of the AMPs belonging to the S100 family, produced by keratinocytes and leukocytes stimulated with IL-17, IL-22 and TNF; therefore, it plays an essential role in innate immunity and angiogenesis9,21. In our study, it was upregulated in sPV compared to mPV, which agrees with previous work showing higher serum levels of psoriasin in patients with severe psoriasis9 and a reduction after treatment with biological agents15. KRT6A is one of the stress keratins that regulate keratinocyte differentiation and correlation to proteins that participate in EGFR and retinoic acid signalling22,23. Our results demonstrated that it was upregulated in DIA but downregulated in the PRM test, which the conclusions of the previous study can explain that individual stress keratin genes are associated with partially distinct gene networks 24.
Neutrophil elastase (NE) is a primary proteinase in neutrophils that participates in microbicidal activity25. Previous research has found that the levels and activity of NE reflect disease state and severity26 and augmented staining in the low-density granulocytes (LDGs) of psoriasis27. However, our results show that NE is down-regulated in sPV. Moreover, SLPI is a reversible NE inhibitor that dynamically controls NE activity. Although SLPI expression decreased in sPV, there was no statistical difference between the two groups. These results indicate that NE has a pleiotropic feature; that is, it has not only antibacterial effects and promotes proinflammatory but also impairs innate immunity 26.
HSP90AA1 is a molecular chaperone which plays an essential role in cell survival, cytokine signalling, and immune response. It can bind bacterial Lipopolysaccharide (LPS) and mediates LPS-induced inflammatory response, including monocyte TNF secretion28. Furthermore, HSP90AA1 released by stressed keratinocytes activate DCs to secrete proinflammatory cytokines and AMPs such as S100A729. Despite previous research finding a significantly decreased expression of HSP90AA1 in both keratinocytes and lymphocytes from psoriatic skin30, this study shows that it is upregulated in sPV. Our data is consistent with another study showing that it is significantly upregulated in epidermal keratinocytes and mast cells of psoriatic lesions and down-regulated after ustekinumab treatment29 .
CD14 act as a co-receptor for toll-like receptors (TLRs) to activate multiple signal pathways of innate immunity responses to pathogens or tissue injury in diverse cells. This function can be achieved by LBP-dependent combination of the CD14-LPS complex or independently of TLRs31. Studies have shown that CD14 + DC3s increased in psoriatic lesions and co-produced IL1B and IL23A32; in contradiction to this, IL-17A blockade induced higher expression of CD1C and CD14, which are markers for CD1c + CD14 + dendritic cell (DC) that suppress antigen-specific T-cell responses, in post-treatment regulatory semimature DCs33. Accordingly, CD14 are down-regulated, along with CD1c, in sPV according to our proteomic dataset. These findings indicate that, although the CD14-mediated immune response to pathogenic microorganisms is weakened, the reduction of CD14 on specific dendritic cell subpopulations attenuates the inhibitory effect on T cells, which leads to the persistence and aggravation of inflammation in psoriasis. This study found CD36, another co-receptor associated with the TLR2/TLR6, was upregulated in sPV. Meanwhile, CD36 has a more vigorous activity for modulating TLR4-TLR6 signal transduction than CD14. So, we speculate that the reduction of CD14 may be related to the competition of the CD36 receptor pathway and the regulation of other proteins.
IL-33 is a cytokine that signals through the IL1RL1/ST2 receptor, which can activate NF-kappa-B and MAPK signalling pathways34 and is a proinflammatory molecule and modulator in psoriasis35–37. However, other studies found that IL-33 exert anti-inflammatory and protective activities in psoriatic skin38,39, which only manifests when the amount of IL-33 is excessive. Considering that IL33 was significantly elevated in sPV, our results agree it is a risk factor for psoriasis. Meanwhile, our results are consistent with previous research that IL-33 can function both as a cytokine and as a nuclear transcriptional regulator39 since it can interact with chaperone proteins to regulate the transcription machinery.
Limitations of the study: (1) The sample size was relatively small. (2) DIA did not detect some low-abundance proteins, as we discussed in our previous study. (3) There are sex differences in patients between the two groups, which may affect the results (Table 1). These confounding factors might affect the results.