Menoufia Medical Journal

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 34  |  Issue : 1  |  Page : 40--42

Serum paraoxonase-1 levels as an indicator of oxidative stress in patients with vitiligo


Shawky M El-Farargy1, Naglaa M Ghanayem2, Eman K Farag3,  
1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Dermatology, Andrology and STDs, Ministry of Health, Menoufia, Egypt

Correspondence Address:
Eman K Farag
Quesna, Menoufia Governate
Egypt

Abstract

Objective To evaluate the use of serum paraoxonase-1 (PON1) activity as an indicator of oxidative stress in patients with active generalized vitiligo. Background Vitiligo is an acquired cutaneous disorder of pigmentation, characterized by destruction of melanocytes. One of the major hypotheses in the pathogenesis of vitiligo is the oxidative stress hypothesis. In patients with vitiligo, lower levels of PON1 prevent lipoprotein peroxidation and oxidation of low-density lipoprotein and cholesterol. Patients and methods A case–control study was conducted on 40 patients: 20 patients with recent active generalized vitiligo and 20 age-matched and sex-matched healthy volunteers served as controls. All the included patients underwent full history taking, full examination, routine laboratory investigations, and assessment of serum PON1. Results The serum PON1 level in patient group A (101.64 ± 25.48) was significantly lower than that in the control group B (181.88 ± 95.12) (P < 0.001). There was a significant negative correlation between serum PON1 level and vitiligo area severity index score (r = −0.780, P < 0.001). Conclusion Vitiligo is probably mediated through a process of oxidative stress and imbalance of oxidant–antioxidant system. Oxidative stress present in vitiligo disease can be determined by measurement of serum PON1 in these patients.



How to cite this article:
El-Farargy SM, Ghanayem NM, Farag EK. Serum paraoxonase-1 levels as an indicator of oxidative stress in patients with vitiligo.Menoufia Med J 2021;34:40-42


How to cite this URL:
El-Farargy SM, Ghanayem NM, Farag EK. Serum paraoxonase-1 levels as an indicator of oxidative stress in patients with vitiligo. Menoufia Med J [serial online] 2021 [cited 2021 Dec 4 ];34:40-42
Available from: http://www.mmj.eg.net/text.asp?2021/34/1/40/311999


Full Text



 Introduction



Vitiligo is an acquired cutaneous disorder of pigmentation, characterized by destruction of melanocytes [1]. The explanation for skin problem still remains unknown [2]. One of the important hypotheses in the pathogenesis of vitiligo is the oxidative stress hypothesis, which is based on the reality of the formation of some toxic metabolites throughout pigment biosynthesis [3]. Oxidative stress results from the overproduction of pro-oxidant species in cells and/or reduction of cellular antioxidant capacity. It can damage nucleic acids, lipids, and proteins, leading to mutagenesis or cell death [4]. Human paraoxonase-1 (PON1) is a Ca2+-dependent esterase synthesized in the liver. PON1 is related to high-density lipoprotein. PON1 has two main roles: detoxifying organophosphate compounds, such as paraoxon, and protecting low-density lipoprotein by hydrolysis of lipid peroxides [5]. Reduced serum PON1 activity has been reported to be associated with some diseases under oxidative stress and inflammation conditions [6]. Antioxidants have a protective role in the development of some autoimmune diseases like psoriasis, vitiligo, and alopecia aerate [7]. PON1 is an antioxidant enzyme and a member of the PON enzyme family, comprising PON1, PON2, and PON3 that degrade bioactive oxidized lipids and are thus antiatherogenic [8]. The aim of this study was to evaluate the serum PON1 activity as an indicator of oxidative stress in patients with active generalized vitiligo.

 Patients and methods



Ethical consideration approval was acquired from the health facility ethics committee, and a written knowledgeable consent has been taken from all the enrolled patients. A case–control study was conducted on 40 patients. The studied patients were classified into two groups:

Group A (patient group) included 20 patients with recent active generalized vitiligo. The active phase of vitiligo was defined as the progression or appearance of new lesions within the previous 3 months [3].

Group B (control group) included 20 healthy volunteers age-matched and sex-matched with patients, who served as controls.

Patients were recruited from the dermatology outpatient clinic in Menoufia University Hospital within the period from January 2018 and February 2019.

Exclusion criteria included presence of chronic diseases such as chronic renal failure, chronic liver disease, or hepatic failure; coronary artery disease concomitant inflammatory disease; autoimmune disorder; diabetes mellitus; familial hypercholesterolemia; neoplastic disease; liver or kidney disease; recent major surgical procedure; patients with segmental vitiligo; patients taking antioxidant drug, vitamins, diuretics, or hormonal replacement therapy; smoker; and those with alcoholism.

All studied participants were subjected to the following: full history taking and complete general; dermatologic examination; and assessment of vitiligo area severity index (VASI), where the percentage of vitiligo involvement is calculated in terms of hand units. One hand unit is approximately equivalent to 1% of the total body surface area.

Venous blood samples were collected from patients and controls and used for measurement of total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol using Hitachi 912 chemistry analyser (Roche Diagnostics GmbH, Mannheim, Germany) and serum PON1 level by enzyme-linked immunosorbent assay kit, provided by Shanghai Sunred Biological Technology Co. Ltd (Shanghai, China).

Data were analyzed using statistical package of social science program (SPSS) for Windows version 22 (SPSS Inc., Chicago, Illinois, USA) and Microsoft Excel. Numerical data were expressed as mean ± SD, whereas categorical data were expressed as number and percentage. Student t-test was used for normally distributed quantitative variables, to compare between two studied groups. Mann–Whitney test was used for abnormally distributed quantitative variables, to compare between two studied groups. Spearman coefficient was used to correlate between two distributed abnormally quantitative variables. All statistical analyses were based on two-sided hypothesis tests, with a significance level of P value less than 0.05.

 Results



In this study, the age of the selected cases ranged between 10 and 71 years, with 34.80 ± 20.53 years as a mean ± SD and 37.50 as a median value. The patients comprised nine (45.0%) males and 11 (55.0%) females. There was nonstatistically significant difference between the two studied groups regarding age and sex (P = 0.277 and 0.342, respectively; [Table 1]).{Table 1}

The serum PON1 level in patient group A (101.64 ± 25.48) was significantly lower than that in the control group B (181.88 ± 95.12) (P < 0.001; [Table 2]).{Table 2}

There was a significant negative correlation between serum PON1 level and VASI score (r = −0.780, P < 0.001; [Figure 1]).{Figure 1}

 Discussion



In this study, the age of patients was between 10 and 71 years, with a mean age of 34.80 years. This in agreement with a previous study, which reported that the mean age of vitiligo is 36.10 years [9]. Another research study denoted that the most common age group affected by active vitiligo is 16–25 years [10]. However, the study was hospital based and including lesser number of patients. In this study, there were a predominance of the disease in the adults, from 20 to 59 years old, which is in agreement with the studies of De Barros and colleagues [11] and Dias and colleagues [12] performed in Brazil; the former reported that the most common age of vitiligo is adult from 20 to 59 years old. In this study, there was female predominance among patients with vitiligo. This is in agreement with the study of Haider and colleagues [13] and Jain and colleagues [14]; the former reported that female predominance can be owing to their more concern in cosmetics and frequent dermatologic consultations. This study found that the mean value of serum PON1 was significant lower in active generalized vitiligo patient group compared with controls. This was in agreement with another study which reported reduced serum PON1 level in patients with active generalized vitiligo compared with controls [3]. The results of this study also agree with a previous study which examined levels of vitamin E and PON1, an important free radical scavenger, in three autoimmune disorders, including vitiligo. It found statistically significantly lower tissue and serum levels of both substances in patients with vitiligo [7]. It reported that oxidative stress is likely to be involved in the etiopathogenesis of vitiligo. Moreover, this finding indicates an evident association between oxidative stress and pathogenesis of vitiligo [10]. Attenuation of oxidative stress, therefore, might be a relevant therapeutic approach, and it would be useful to recommend additional drugs with antioxidant effects in the treatment [7]. This study showed significant correlation between serum PON1 and VASI score. This was in agreement with another study which reported that the finding of a PON1 decrease in patients with vitiligo emphasizes the oxidative stress hypothesis in the progression of the disease, and it can highlight the effect of free radicals, leading to oxidative damage in vitiligo disease. There is a significant correlation between serum PON1 and VASI score. This may point to the value of serum PON1 as prognostic marker for evaluating the disease activity. This is an area that requires additional research [3].

 Conclusion



Vitiligo is probably mediated through a process of oxidative stress and imbalance of oxidant–antioxidant system. Oxidative stress present in vitiligo disease can be determined by measurement of serum PON1 in these patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Das A, Panda S. Use of topical corticosteroids in dermatology: an evidence based approach. Indian J Dermatol 2017; 62:237–250.
2Arora AK, Kumaran MS. Pathogenesis of vitiligo: an update. Pigment Int 2017; 4:65–77.
3Yesilova Y, Turan E, Ucmak D, Selek S, Yavuz IH, Tanrıkulu O. Reduced serum paraoxonase 1 level in vitiligo: further evidence of oxidative stress. Redox Rep 2012; 17:214–218.
4Denat L, Kadekaro AL, Marrot L, Leachman SA, Abdel-Malek ZA. Melanocytes as instigators and victims of oxidative stress. J Invest Dermatol 2014; 134:1512–1518.
5Atasoy H, Güleç-Yilmaz1 S, Ergen A, Görmüş U, Küçükhüseyin Ö, Dalan B, et al. Paraoxonase1 192 (PON1 192) gene polymorphism and serum paraoxonase activity in panic disorder patients. In Vivo 2015; 29:51–54.
6Esen R, Aslan M, Kucukoglu ME, Cıkman A. Serum paraoxonase activity, total thiols levels, and oxidative status in patients with acute brucellosis. Wien Klin Wochenschr 2015; 127:427–433.
7Ramadan R, Tawdy A, Abdel Hay R, Rashed L, Tawfik D. The antioxidant role of paraoxonase 1 and vitamin E in three autoimmune diseases. Skin Pharmacol Physiol 2013; 26:2–7.
8Marsillach J, Camps J, Beltran-Debón R, Rull A, Aragones G, Maestre-Martínez C, et al. Immunohistochemical analysis of paraoxonases-1 and 3 in human atheromatous plaques. Eur J Clin Invest 2011; 41:308–314.
9Chinthaamani KPR. An epidemiological study of vitiligo in an Urban City Hospital. Acta Sci Med Sci 2018; 2:7–12.
10Pande S, Gupta M. Study of oxidative stress in vitiligo panacea. J Med Sci 2017; 7:89–91.
11De Barros JC, Machado Filho CD, Abreu LC, de Barros JA, Paschoal FM, Nomura MT, et al. A study of clinical profiles of vitiligo in different ages: an analysis of 669 outpatients. Int J Dermatol 2014; 53:842–848.
12Dias AD, Pires CA, dos Santos Neto AA, de Oliveira BP, da Silva TP, Mainardi CR, et al. Clinical and epidemiological study of vitiligo patients at a dermatology service in Northern Brazil. Int Arch Med 2018; 11:28–32.
13Haider N, Islam MS, Al Maruf A, Shohag MH, Ali R, Rahman GK, et al. Oxidative stress and antioxidant status in vitiligo patients. J Pharm Sci 2010; 9:103–108.
14Jain A, Mal J, Mehndiratta V, Chander R, Patra SK. Study of oxidative stress in vitiligo. Indian J Clin Biochem 2011; 26:78–81.