Introduction: Psoriasis is a prevalent immune-mediated disease involving primarily the skin. Infiltrating leukocytes play key roles in driving the disease. Along with an array of adhesion proteins, leukocyte trafficking into tissue is controlled by chemoattractants, including chemokines, and their receptors. This review summarizes the data on roles for the chemokine system in psoriasis in order to highlight opportunities for inhibiting this system for therapeutic benefit.
Areas covered: The review covers the roles of various leukocyte subsets in psoriasis, focusing on the chemokine receptors that are thought to be responsible for the trafficking of these cells into tissue. The review also discusses in some detail the significance of the IL-23/IL-17/IL-22 cytokine axis in disease.
Expert opinion: Many of the new therapies developed for psoriasis are antibodies to neutralize cytokines that have pleiotropic functions in host defense. Inhibiting chemokine receptors can be accomplished using small molecules, and would be expected to block inflammation while resulting in more limited immunosuppression. There has been limited success to date in treating inflammatory disease with chemokine receptor antagonists, which has often been ascribed to the system's redundancy. Other factors may also be important, however, including sub-optimal choices of targets based on incomplete understandings of disease pathogenesis.