Investigating the role of insulin in psoriasis development

Role of Insulin Action in Psoriasis Pathogenesis

This study is trying to see if insulin plays a role in the development of psoriasis by looking at skin samples from people with the condition.

Quick facts

• Study type: Observational
• Enrollment: 18 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: Columbia University (other)
• Drugs / interventions: cyclophosphamide
• Locations: 1 site (New York, New York)
• Trial ID: NCT06242847 on ClinicalTrials.gov

What this trial studies

This observational study aims to gather information from individuals with plaque psoriasis to explore the potential role of insulin in the disease's pathogenesis. Participants will undergo punch biopsies of both lesional and non-lesional skin after fasting and during an oral glucose tolerance test. The study will assess insulin action by measuring the phosphorylation of AKT, a key mediator in insulin signaling, in the collected biopsy specimens. The hypothesis is that insulin signaling may be hyperactive in psoriatic lesions despite the presence of insulin resistance elsewhere in the body.

Who should consider this trial

Good fit: Ideal candidates are individuals diagnosed with plaque psoriasis who are overweight or obese, with a body mass index between 25.0 and 40.0 kg/m2.

Not a fit: Patients with psoriasis who are not overweight or obese, or those with a body mass index below 25.0 kg/m2, may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to a better understanding of the relationship between insulin and psoriasis, potentially informing new treatment strategies.

How similar studies have performed: While the connection between insulin resistance and psoriasis has been noted, this specific approach to investigate insulin signaling in psoriatic lesions is novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

1. Body mass index of 25.0-40.0 kg/m2
2. Able to understand written and spoken English and/or Spanish
3. Written informed consent (in English or Spanish) and any locally required authorization (e.g., Health Insurance Portability and Accountability Act) obtained from the participant prior to performing any protocol-related procedures, including screening evaluations.
4. Diagnosed with plaque psoriasis, documented using Psoriasis Area and Severity Index (PASI)
5. Glucose metabolism status as follows (determined only retrospectively based on data collected during the study):

   * For Insulin Sensitive (IS) group:

     * Hemoglobin A1c \< 5.7%, and
     * Fasting plasma glucose \< 95 mg/dL, and
     * Fasting plasma insulin \< 10 μIU/mL
   * For Insulin Intermediate (II) group:

     * Hemoglobin A1c \< 6.5%, and
     * Fasting plasma glucose 80-125 mg/dL, and
     * Fasting plasma insulin 10-14 μIU/mL
   * For Insulin Resistant (IR) group:

     * Hemoglobin A1c \< 6.5%, and
     * Fasting plasma glucose 80-125 mg/dL, and
     * Fasting plasma insulin ≥ 15 μIU/mL

Exclusion Criteria:

1. Inability to provide informed consent in English or Spanish
2. Concerns arising at screening visit (any of the following):
3. Laboratory evidence of diabetes mellitus, either determined during the study or based on previous documentation:

   * Hemoglobin A1c ≥ 6.5%, and/or
   * Fasting plasma glucose ≥ 126 mg/dL
   * Plasma glucose ≥ 200 mg/dL at 2 hours after ingestion of a 75-g oral glucose load
   * Random plasma glucose ≥ 200 mg/dL associated with typical hyperglycemic symptoms, diabetic ketoacidosis, or hyperglycemic-hyperosmolar state
4. History of gestational diabetes mellitus
5. Use of antidiabetic medications within the 90 days prior to screening, including those prescribed for other indications (e.g., weight control, restoration of ovulation in of polycystic ovarian syndrome), including:

   • Metformin, thiazolidinediones, sulfonylureas, meglitinides, dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium/glucose cotransporter 2 (SGLT2) inhibitors, amylin mimetics, acarbose, insulin
6. Clinical concern for absolute insulin deficiency (e.g., type 1 diabetes, pancreatic disease)
7. Reproductive concerns

   i. Women of childbearing potential not using highly effective contraception, defined as:
   * Surgical sterilization (e.g., bilateral tubal occlusion, bilateral oophorectomy and/or salpingectomy, hysterectomy)
   * Combined oral contraceptive pills taken daily, including during the study
   * Intrauterine device (levonorgestrel-eluting or copper) active at the time of the study
   * Medroxyprogesterone acetate (Depo-Provera®) injection active at the time of the study
   * Etonogestrel implants (e.g., Implanon®, etc.) active at the time of the study
   * Norelgestromin/ethinyl estradiol transdermal system (e.g., Ortho-Evra®) active at the time of the study

   ii. Women currently pregnant

   iii. Women currently breastfeeding
8. Known, documented history, at the time of screening, of any of the following medical conditions:

   i. Bleeding disorders, including due to anticoagulation or use of P2Y12 inhibitors ii. Anemia requiring treatment iii. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
9. Use of medications associated methemoglobinemia within 48 hours of shave biopsy procedures:

   i. Nitrates/nitrites: nitric oxide, nitroglycerin, nitroprusside, nitrous oxide ii. Antineoplastics: cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase iii. Antibiotics: dapsone, nitrofurantoin, paraaminosalicylic acid, sulfonamides iv. Antimalarials: chloroquine, primaquine v. Anticonvulsants: phenobarbital, phenytoin, valproic acid vi. Others: acetaminophen, metoclopramide, quinine, sulfasalazine
10. History of severe infection or ongoing febrile illness within 30 days of screening
11. Any other disease, condition, or laboratory value that, in the opinion of the investigator, would place the participant at an unacceptable risk and/or interfere with the analysis of study data.
12. Known allergy/hypersensitivity to any component of the medicinal product formulations (including amide anesthetics), IV infusion equipment, plastics, adhesive or silicone, history of infusion site reactions with IV administration of other medicines, or ongoing clinically important allergy/hypersensitivity as judged by the investigator.
13. Concurrent enrollment in another clinical study of any investigational drug therapy within 6 months prior to screening or within 5 half-lives of an investigational agent, whichever is longer.

Where this trial is running

New York, New York

• Columbia University Irving Medical Center — New York, New York, United States (RECRUITING)

Study contacts

• Principal investigator: Joshua R Cook, MD, PhD — Columbia University
• Study coordinator: Joshua R Cook, MD, PhD

Conditions: Psoriasis, Plaque Psoriasis, Insulin Resistance, PreDiabetes, Overweight and Obesity, Insulin, Insulin resistance