110th Congress

Psoriasis and Psoriatic Arthritis Research, Cure, and Care Act of 2007

H.R. 1188 / S. 1459

Background

Psoriasis is a skin disease that causes scaling and swelling. Skin cells grow deep in the skin and slowly rise to the surface in a process called cell turnover that usually takes about a month. With psoriasis, this can happen in just a few days because the cells rise too fast and accumulate on the surface of the skin.

Most psoriasis causes patches of thick, red skin with silvery scales. These patches may itch or feel sore. They are often found on the elbows, knees or other parts of the leg, scalp, lower back, face, palms, and soles of the feet. They can also appear in other places, such as the fingernails, toenails, genitals, and inside of the mouth. People with psoriasis may also experience joint inflammation that produces symptoms of arthritis, a condition called psoriatic arthritis.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) funds a variety of research aimed at uncovering the cellular and molecular processes that contribute to the development of psoriasis and psoriatic arthritis, expanding our knowledge of genes that play a role in causing these diseases, and discovering more effective treatments to improve the quality of life for adults and children suffering from these conditions.

In recent years, the investment of research dollars has led to several significant advances. For example, NIAMS-supported researchers recently found similarities in genetic susceptibility for psoriasis and atopic dermatitis, another inflammatory skin disease. As for psoriatic arthritis, researchers have found that the presence of modifier genes can indicate which individuals with psoriasis are also at risk for psoriatic arthritis.

Other NIAMS-supported researchers have developed an animal model to demonstrate how the proliferation of T cells, which help protect the body against infection and disease, is key to the formation of psoriatic lesions. They also demonstrated the role of a molecule involved in the inflammation process, known as tumor necrosis factor alpha, in the development of psoriatic lesions and T-cell growth. In another study, a team of scientists used psoriasis as a model disease to develop a method of identifying autoantigens (substances found naturally within the body that can trigger an immune response) for autoimmune diseases. The investigators found three autoantigens that are likely related to psoriasis and were associated with significant reactions in patients.

Genetic research supported by NIAMS has already led to the discovery of a gene called PSORS-1, which plays a role in determining who develops psoriasis. Researchers examined genetic samples from families in which some members had early-onset psoriasis, and they identified a specific gene allele (an alternate form of a gene) as the one that confers susceptibility to this form of the disease. Other researchers are building on these discoveries in order to further understanding of how PSORS-1 and related genes increase susceptibility to psoriasis. The benefit of finding the gene that makes people susceptible to developing psoriasis is that this may allow scientists to examine targeted therapies that could result in the prevention or improved treatment of the disease. Current treatments for psoriasis often suppress the entire immune system, leaving the person vulnerable to infection. Ideally, treatments aimed at a particular gene would shut down only the process that causes the disease, which would provide relief without affecting the immune system.

NIAMS-supported researchers have also demonstrated a connection between psoriasis and increased risk for other diseases, such as cardiovascular disease. The same inflammatory process that speeds up the growth cycle of skin cells in psoriasis is also involved in promoting blockages of arteries and ultimately causing ruptures of plaques, leading to heart attacks. The risk is nearly doubled in younger patients (30–40 years old) with severe psoriasis, compared with those without the disease.

Provisions of the Legislation/Impact on NIH

The legislation would require the Secretary of Health and Human Services (HHS), acting through NIAMS, to expand and intensify psoriasis and psoriatic arthritis research and related activities, including:

• Basic research to discover the pathogenesis and pathophysiology of the disease
• Expansion of molecular genetics and immunology studies, including additional animal models
• Global association mapping with single nucleotide polymorphisms
• Identification of environmental triggers and autoantigens for psoriasis
• Elucidation of specific immune receptor cells and their products involved
• Pharmcogenetic studies to understand the molecular basis for varying patient response to treatment
• Identification of genetic markers of psoriatic arthritis susceptibility
• Research to increase the understanding of joint inflammation and destruction in psoriatic arthritis
• Clinical research for the development and evaluation of new treatments, including new biological agents
• Research to develop improved diagnostic tests
• Research to increase understanding of co-morbidities and psoriasis, including shared molecular pathways

The bill would also require the Centers for Disease Control and Prevention to establish a patient registry of individuals with psoriasis. In addition, the Secretary of HHS would be required to convene a national summit on the disease and contract with the Institute of Medicine to conduct a study regarding insurance coverage for patients.

Status and Outlook

H.R. 1188 was introduced by Representative David Wu (D-OR) on February 16, 2007, and was referred to the House Committee on Energy and Commerce. No further action has occurred on this legislation.

S. 1459 was introduced by Senator Robert Menendez (D-NJ) on May 23, 2007, and was referred to the Senate Committee on Health, Education, Labor and Pensions.  No further action has occurred on this legislation.

June 2008