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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic systemic inflammatory disease&#44; affecting 1&#37; to 2&#37; of the population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its pathogenesis is multifactorial&#44; and not yet fully understood&#44; but it involves&#44; in addition to a genetic basis and environmental stimuli&#44; the activation of the immune system &#40;innate and adaptive&#41;&#44; which triggers local inflammatory responses in the skin and joints&#44; as well as promoting low-grade systemic inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Comorbidities such as obesity&#44; arterial hypertension&#44; diabetes mellitus&#44; metabolic syndrome&#44; cardiovascular disease&#44; dyslipidemia&#44; and affective disorders &#40;depression&#44; anxiety&#41; are frequent in patients with psoriasis&#44; corroborating the underlying systemic inflammatory process&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The intestinal microbiome &#40;IM&#41; consists of an inconstant flora&#44; established in the first years of life&#44; but which varies according to environmental stimuli&#44; such as diet&#44; lifestyle &#40;smoking&#44; alcohol consumption&#44; physical exercise&#44; stress&#44; sleep&#41;&#44; hygiene&#44; therapy with antimicrobials&#44; geographic location&#44; sex&#44; age&#44; and certain diseases&#46; About 57&#37; of the IM is influenced by diet and only 12&#37; by genetic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> There are between one and two thousand species of bacteria in the fecal microbiome&#44; distributed in more than fifty phyla&#46; About 90&#37; of the IM consists of the <span class="elsevierStyleItalic">Firmicutes</span> and <span class="elsevierStyleItalic">Bacteroidetes</span> phyla&#44; where a higher <span class="elsevierStyleItalic">Firmicutes&#47;Bacteroidetes</span> &#40;F&#47;B&#41; ratio is associated with a greater systemic inflammatory stimulus&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Intestinal dysbiosis&#44; characterized by IM composition imbalance&#44; can lead to increased intestinal permeability and translocation of intraluminal inflammatory mediators&#46; Therefore&#44; the characterization of IM can contribute to the understanding of the pathogenesis of systemic inflammatory diseases&#44; such as psoriasis&#44; Crohn&#39;s disease&#44; rheumatoid arthritis&#44; and obesity&#44; since there are indications that IM composition is involved in their course&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical studies have been conducted to explore the association between IM and psoriasis clinical activity with conflicting results&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However&#44; MI modulation through dietary treatment&#44; supplementation with probiotics&#44; and fecal transplantation is considered to have the potential to interfere with the course of comorbidities&#44; in addition to psoriasis activity&#44; as well as maximizing therapeutic response&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Lipopolysaccharide &#40;LPS&#41; is an endotoxin that constitutes the cell wall of gram-negative bacteria and promotes the immune system activation by direct stimulation of macrophages&#44; monocytes&#44; dendritic cells and B lymphocytes&#44; triggering fever&#44; vasodilation &#40;nitric oxide&#41;&#44; and eicosanoid secretion&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Lipopolysaccharide-binding protein &#40;LPB&#41; binds to LPS and transfers LPS monomers to inflammatory cells via CD14&#46; Plasma levels of LPB are influenced by circulating levels of LPS&#44; which have a very short half-life&#46; Exposure to LPS induces a lasting increase in LPB production in the liver within 15 to 30<span class="elsevierStyleHsp" style=""></span>minutes&#44; with a peak serum level occurring after 24 to 48<span class="elsevierStyleHsp" style=""></span>hours&#46; The LPS-LBP-CD14-MD2 complex induces a pro-inflammatory response through toll-like-4 &#40;TLR4&#41; receptor-mediated NF-&#954;B activation&#44; and thus&#44; circulating levels of LPB have been associated with systemic inflammation&#46; Additionally&#44; plasma levels of highly-sensitive quantitative C-reactive protein &#40;hs-CRPqt&#41;&#44; a serum biomarker of systemic inflammation synthesized by the liver&#44; are associated with increased LPS&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Controlled studies characterizing IM in patients with psoriasis are rare in South America&#46; Therefore&#44; the aim of this investigation was to characterize IM of Brazilian adult men with psoriasis&#44; in comparison with omnivore and vegetarian controls&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Method</span><p id="par0040" class="elsevierStylePara elsevierViewall">This was a cross-sectional study involving 42 adult males &#40;aged 21 to 65 years&#41;&#58; 21 with psoriasis &#40;PSO&#41;&#59; and 21 controls without psoriasis&#58; 14 omnivores &#40;OMNI&#41;&#44; and seven vegetarians &#40;VEG&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All participants included in the study were non-smokers&#44; non-alcoholics&#44; had not changed their diet in the last three months&#59; did not use antibiotics&#44; laxatives&#44; or anti-inflammatory drugs&#44; or reported intestinal changes in the previous week&#44; and did not have inflammatory bowel disease&#44; infections&#44; autoimmune diseases or used probiotics&#46; The sample of adult men from the interior of the state of S&#227;o Paulo was chosen to aim reducing MI variability&#44; which is also influenced by sex&#44; age&#44; and geographic location of the population&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the Human Research Ethics Committee of the Botucatu Faculty of Medicine &#8211; FMB&#47;UNESP &#40;Counsel number 3&#44;743&#44;366&#41;&#59; and all participants signed the Free and Informed Consent Form&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study was carried out at the Dermatology Outpatient Clinic of Botucatu Faculty of Medicine&#44; from March 2020 to February 2021&#46; The population comprised individuals who lived in the area of Botucatu&#44; the state of S&#227;o Paulo&#44; comprising patients diagnosed with psoriasis&#44; their companions&#44; and vegetarians who were invited to participate&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Clinical&#44; demographic&#44; socioeconomic&#44; and dietary data were obtained through in-person interviews&#59; anthropometric and dietary assessments were performed by an experienced nutritionist &#40;T&#46;C&#46;F&#46;P&#46;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The dietary assessment was obtained using the 24-h recall &#40;R24<span class="elsevierStyleHsp" style=""></span>h&#41; method&#44; based on a detailed account of food consumption in the last 24<span class="elsevierStyleHsp" style=""></span>hours&#44; including data on types of foods and beverages&#44; in addition to sizes&#44; portions&#44; volume&#44; or household measurements&#46; Subsequently&#44; data were transformed into grams&#44; energy values&#44; macronutrients&#44; and micronutrients using the Nutritional Data System for Research &#40;NDSR&#41; software&#46; To estimate disease severity&#44; the PASI &#40;Psoriasis Area and Severity Index&#41; score was used&#44; which was evaluated by a certified dermatologist &#40;L&#46;D&#46;B&#46;M&#46; or M&#46;R&#46;R&#46;L&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">To assess IM&#44; stool samples were collected to obtain the genetic material&#46; The individuals were instructed to perform the stool collection in a specific tube in their homes&#44; consisting of the first evacuation of the day&#46; After collection&#44; the stool samples were delivered to the researcher in charge &#40;T&#46;C&#46;F&#46;P&#46;&#41; and transported while refrigerated &#40;dry ice&#58; &#8722;28<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; to the Biotechnology Research and Innovation Laboratory &#40;BPI&#44; <span class="elsevierStyleItalic">Biotecnologia Pesquisa e Inova&#231;&#227;o</span>&#44; Botucatu-SP&#41;&#44; and stored in a freezer at -80<span class="elsevierStyleHsp" style=""></span>&#176; C until the time of DNA extraction&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">To extract the genetic material&#44; 1<span class="elsevierStyleHsp" style=""></span>g aliquots and the Quick-DNA Fungal&#47;Bacterial Miniprep kit &#40;Zymo Research&#41; were used according to the protocol described by the manufacturer&#46; Subsequently&#44; the material underwent a quality test through fluorescence quantification using the Qubit&#174; 3&#46;0 Fluorometer &#40;Thermo Fisher Scientific&#41; equipment&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Sample triplicates were used for amplification reactions of the 16S region&#44; with a final volume of 20<span class="elsevierStyleHsp" style=""></span>&#956;L&#44; containing 10<span class="elsevierStyleHsp" style=""></span>&#956;L of GoTaq&#174; Colorless Master Mix 2&#215; &#40;Promega&#44; USL&#41;&#44; 0&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;M of forward oligonucleotide and 0&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;M of the reverse oligonucleotide&#44; 3<span class="elsevierStyleHsp" style=""></span>&#956;L of genomic DNA&#44; and sufficient sterile ultrapure water to make up 20<span class="elsevierStyleHsp" style=""></span>&#956;L&#46; Amplification reactions were carried out in a Veriti&#8482; Thermal Cycler &#40;Applied Biosystems&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">After the DNA amplification reaction of each sample&#44; proof of amplification was performed through electrophoresis in 2&#37; agarose gel stained with Gel Red &#40;Uniscience&#41;&#44; approximately 300 bp &#40;amplicon size&#41;&#46; PCRs were submitted to purification steps using Agencourt AMPure XP magnetic bead &#40;Beckman Coulter&#41;&#44; to remove very small fragments from the total population of molecules and remnants of primers from the reaction&#46; After this step&#44; the quantification was performed using Real-Time PCR methodology using QuantStudio 3 Real-Time thermal cycler &#40;Applied Biosystems&#41; and the KAPA-KK4824 kit &#40;Library Quantification Kit &#8210; Illumina&#47;Universal&#41;&#44; all according to the manufacturer protocol&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">An equimolar pool of DNA was generated by normalizing all samples to 3<span class="elsevierStyleHsp" style=""></span>nM to perform sequencing&#44; which was carried out using the Illumina MiSeq next-generation sequencing system &#40;Illumina Sequencing&#41; and the MiSeq Reagent Kit V2 Nano 300 cycles &#8211; reading of 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>150bp&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The Greengenes 13&#95;8 99&#37; OTUs database from 515<span class="elsevierStyleHsp" style=""></span>F&#47;806R region of sequences was used to identify taxon sequences and only sequences with more than 97&#37; analogy &#40;reliability&#41; were considered&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The relative abundance of taxonomic units &#40;TU&#41; in the samples was explored based on their components extracted by the PLS &#40;Partial Least Squares&#41; method&#44; with data scaled by standard deviations&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The main study variables are the diversity of the intestinal flora identified in each evaluated IM&#44; according to each taxonomic unit &#40;TU&#41; category&#58; relative abundance of the groups&#44; by the Hill diversity indices &#40;richness&#44; Shannon and Simpson&#41;&#44; the ratio between the <span class="elsevierStyleItalic">Firmicutes&#47;Bacteroidetes</span> phyla&#44; the abundance of bacterial genera &#40;alpha diversity&#41;&#44; and the components of the PLS patterns &#40;beta diversity&#41;&#44; identified for the groups&#46; Richness is defined as the total number of TU identified in the sample&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Samples of 10<span class="elsevierStyleHsp" style=""></span>mL of blood were also collected from patients at the dermatology outpatient clinic&#44; by the physician responsible for treating the patients &#40;M&#46;R&#46;R&#46;L&#46;&#41; for the assessment of serum LPB and hs-CRPqt&#46; After collection&#44; the samples were immediately taken under refrigeration to the Experimental Research Unit &#40;UNIPEX&#41; of FMB-Unesp&#44; for centrifugation and serum extraction&#46; For LPB analysis&#44; the ELISA &#40;Enzyme-Linked Immunosorbent Assay&#41; sandwich method was used&#44; according to the kit manufacturer recommendations &#40;Human LBP DuoSet ELISA &#8210; DY870-05&#44; R&#38;D Systems&#44; Inc&#46;&#44; Minneapolis&#44; MN&#44; USA&#41;&#44; with the samples being diluted at 1&#58;500&#46; Final concentrations of LPB were determined according to the standard curve&#46; The CRPqt analyses were performed using the immunoturbidimetry method&#46; Values of CRPqt &#8804; 3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and LPB<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mg&#47;mL were considered normal&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Qualitative variables were represented by percentages&#46; Quantitative variables were represented as means and standard deviations if normality was verified by the Shapiro-Wilks test&#44; or medians and quartiles &#40;P25&#8211;P75&#41; if indicated&#46; The abundance of genera were compared between groups using the Kruskal-Wallis test&#46; Ecological diversity indices were compared between groups using generalized linear models&#44; adjusted for age&#46; The models were adjusted to the most appropriate probability distributions for each sample &#40;e&#46;g&#46;&#44; gamma&#41;&#44; and correction for multiple comparisons was performed using the &#352;id&#225;k procedure&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The loads of PLS components were correlated with nutritional data&#44; LPB levels&#44; and hs-CRPqt by Spearman correlation test&#44; and represented as a heat map&#46; The data were tabulated in MS Excel 2010 and analyzed in IBM SPSS 25v and Statistica 10v software&#46; Statistical significance was defined as p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; two-tailed&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">As this is an exploratory study&#44; convenience sampling was used to determine the global behavior of the groups and support the detailed analysis of samples <span class="elsevierStyleItalic">a posteriori</span>&#46; Moreover&#44; the PLS method does not require a minimum sampling size to be performed&#46; For the bivariate correlation analyses&#44; a sample of 41 participants is considered sufficient to detect a moderate correlation &#40;rho &#60; 0&#46;70&#41;&#44; considering an &#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01 and power of 90&#37;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">The main clinical&#44; demographic&#44; dietary data&#44; serum LPB&#44; and hs-CRPqt levels are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Age and BMI of the PSO and OMNI groups were higher than those of the VEG group&#46; From the dietary point of view&#44; the PSO and OMNI groups reported higher consumption of carbohydrates and proteins than the VEG group&#46; As for dietary fiber&#44; the PSO group reported lower fiber intake than the OMNI and VEG groups&#46; Plasma levels of LPB&#44; as well as levels of hs-CRPqt&#44; were higher in the PSO group in relation to the VEG group&#59; however&#44; hs-CRPqt levels were higher in the PSO group compared to the OMNI group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">No VEG controls or OMNI individuals with normal weight showed high LPB values&#59; however&#44; one obese OMNI individual&#44; one PSO patient with normal weight&#44; and two obese PSO patients showed LPB<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mg&#47;mL&#46; Similarly&#44; no VEG or OMNI controls with normal weight showed high values of hs-CRPqt&#59; however&#44; two obese OMNI individuals&#44; four PSO patients with normal weight&#44; and three obese PSO patients showed CRP levels &#62; 3<span class="elsevierStyleHsp" style=""></span>mg&#47;mL&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Among patients with psoriasis&#44; eight &#40;32&#37;&#41; presented joint disease&#44; six &#40;24&#37;&#41; were treated exclusively with topical drugs&#44; six &#40;24&#37;&#41; used methotrexate&#44; eight &#40;32&#37;&#41; used acitretin&#44; and five &#40;20&#37;&#41; used secukinumab&#46; The PASI score ranged from 1 to 18&#44; with a median &#40;P<span class="elsevierStyleInf">25</span>&#8211;P<span class="elsevierStyleInf">75</span>&#41; of 4 &#40;1&#8211;7&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As for the comorbidities&#44; among patients with psoriasis&#44; two &#40;17&#37;&#41; had diabetes mellitus&#44; three &#40;25&#37;&#41; had arterial hypertension&#44; and five &#40;42&#37;&#41; had dyslipidemia&#46; Among the omnivore controls&#44; two &#40;13&#37;&#41; had diabetes&#44; four &#40;28&#37;&#41; had arterial hypertension and six &#40;43&#37;&#41; had dyslipidemia&#46; None of the vegetarian controls had comorbidities&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The analysis of IM of the participants resulted in the identification of 1&#44;496 different taxonomic units &#40;TU&#41;&#44; grouped into 94 genera &#40;Supplementary&#41;&#46; IM ecological diversity indices differed between the groups&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; When adjusted for age and BMI&#44; the phylum <span class="elsevierStyleItalic">Firmicutes</span> was less abundant in VEG&#44; and the F&#47;B ratio was higher in the PSO than in the VEG group&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">When comparing obese patients with psoriasis patients and obese controls&#44; the F&#47;B ratio showed no difference &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;078&#41;&#46; However&#44; when individuals with psoriasis and normal weight were compared to controls with normal weight&#44; patients with psoriasis had higher mean values &#40;SD&#41; of the F&#47;B ratio &#40;12&#46;1 &#91;2&#46;9&#93; vs&#46; 2&#46;0 &#91;1&#46;0&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Regarding alpha-diversity&#44; among the 13 most prevalent genera in the three groups &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; a greater proportion of the genus <span class="elsevierStyleItalic">Prevotella</span> &#40;36&#37;&#41; was identified in the VEG group and <span class="elsevierStyleItalic">Blautia</span> in the PSO &#40;14&#37;&#41; and OMNI &#40;18&#37;&#41; groups&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Regarding the PSO group&#44; there was a difference in the abundance of the genera <span class="elsevierStyleItalic">Prevotella</span>&#44; <span class="elsevierStyleItalic">Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Dorea</span>&#44; <span class="elsevierStyleItalic">Bifidobacterium</span> and <span class="elsevierStyleItalic">Coprococcus</span>&#44; when compared to the VEG group&#46; The genera <span class="elsevierStyleItalic">Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Collinsella</span>&#44; <span class="elsevierStyleItalic">Desulfovibrio</span>&#44; on the other hand&#44; differed between the PSO and OMNI groups &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">As for beta diversity&#44; two PLS components represented up to 79&#46;5&#37; of the subgroup variance&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> depicts the projection of cases according to the component loads&#44; individualizing them in different quadrants&#46; The plsPSO pattern can be understood as the negative loadings of PLS1 and 2 &#40;plsPSO &#61; -PLS1-PS2&#41;&#59; conversely&#44; the plsVEG pattern can be represented by the positive loadings of PLS1 and 2 &#40;plsPVEG<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>PLS1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PLS2&#41;&#59; the plsOMNI pattern can be represented by the positive loading of PS1 and negative loading of PS2 &#40;plsOMNI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>PLS1-PLS2&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">TU loadings according to PLS1 and 2 are shown in Supplementary Fig&#46; 1&#46; According to the plsPSO components&#44; the bacteria with the highest IM pattern loading in the PSO group were from the genera <span class="elsevierStyleItalic">Coprococcus</span>&#44; <span class="elsevierStyleItalic">Lachnospira</span>&#44; <span class="elsevierStyleItalic">Paraprevotella</span>&#44; and the species <span class="elsevierStyleItalic">Faecalibacterium prausnitzii</span> sp&#46;&#44; <span class="elsevierStyleItalic">Prevotella stercorea</span> sp&#46;&#44; <span class="elsevierStyleItalic">Prevotella copri</span> sp&#46;&#44; and <span class="elsevierStyleItalic">Ruminococcus callidus</span> sp&#46; On the other hand&#44; those with the lowest load were from the genera <span class="elsevierStyleItalic">Lactobacillus</span>&#44; <span class="elsevierStyleItalic">Streptococcus</span>&#44; <span class="elsevierStyleItalic">Dialister</span>&#44; <span class="elsevierStyleItalic">Megasphaera</span>&#44; Slackia&#44; and the species <span class="elsevierStyleItalic">Bacteroides fragilis</span> sp&#46;&#44; <span class="elsevierStyleItalic">Bacteroides uniformis</span> sp&#46;&#44; <span class="elsevierStyleItalic">Blautia producta</span> sp&#46;&#44; <span class="elsevierStyleItalic">Butyricicoccus pullicaecorum</span> sp&#46;&#44; and <span class="elsevierStyleItalic">Parabacteroides distasonis</span> sp&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows the correlations between levels of LPB&#44; hs-CRPqt&#44; nutritional intake and IM patterns&#58; PSO&#44; OMNI&#44; and VEG&#46; LPB levels were inversely correlated with fiber intake &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>-0&#46;53&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; but positively correlated with the IM pattern component of patients with psoriasis &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;39&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46; 02&#41;&#46; The behavior of hs-CRPqt was not associated with the plsPSO pattern component &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;28&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;11&#41;&#44; but with carbohydrate intake &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;41&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; and with LPB levels &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; From the dietary point of view&#44; the IM pattern plsPSO component was strongly and negatively correlated with fiber intake &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>-0&#46;71&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; as well as lower fiber intake was associated with higher levels of LPB and hs-CRPqt&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">The present study indicated that IM characteristics of adult men with psoriasis differed from omnivore and vegetarian controls living in the same area of Brazil&#46; Age&#44; dietary&#44; and body composition aspects may also contribute to these differences&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">In this sample&#44; the PSO group had a higher intake of carbohydrates&#59; however&#44; with a low fiber intake&#44; showing a higher F&#47;B ratio in IM than the VEG group&#44; which had a higher fiber intake and less abundance of <span class="elsevierStyleItalic">Firmicutes</span>&#46; Additionally&#44; the eating habits of patients with psoriasis were unbalanced&#44; as an increase in low-quality fats and high caloric density were also identified&#44; characteristic of the Western diet&#44; which is associated with intestinal dysbiosis and reduced bacterial diversity&#46; These dietary habits may correlate with disease severity and comorbidities&#44; since the consumption of saturated fats&#44; sugars&#44; beef&#44; and alcohol interfere with the systemic inflammatory status&#44; whereas&#44; dietary fiber intake may contribute to the suppression of certain inflammatory pathways and the induction of regulatory T-cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Intestinal dysbiosis also acts on the imbalance of short chain fatty acids &#40;SCFA&#41;&#44; of which butyrate and acetate are the most studied ones&#44; produced from fiber fermentation by intestinal bacteria&#46; Acetate is associated with the production of ghrelin&#44; which controls appetite and insulin resistance&#44; while butyrate is a source of energy for intestinal cells&#44; associated with systemic inflammation prevention and reduction and increased bacterial diversity&#44; favoring the proliferation of bacteria of the <span class="elsevierStyleItalic">Bacteroidetes</span> phylum&#46; Diets high in fibers&#44; vegetables&#44; and fruits promote an increase in <span class="elsevierStyleItalic">Bacteroidetes</span> and&#44; consequently&#44; greater bacterial diversity&#46; On the other hand&#44; diets with an excess of fried foods&#44; sodium&#44; protein&#44; and animal fat may lead to greater systemic pro-inflammatory activation and F&#47;B ratio in IM&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Moreover&#44; SCFA is a direct modulator of IL-17 synthesis by T-lymphocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Intestinal dysbiosis can promote an intraluminal increase in LPS&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and diets with low nutritional quality &#40;e&#46;g&#46;&#44; the Western diet&#41;&#44; physical and psychological stress&#44; and certain medications &#40;e&#46;g&#46;&#44; antimicrobials&#41;&#44; are factors that favor increased intestinal permeability&#46; A more permeable intestine favors the translocation of LPS into the bloodstream &#40;metabolic endotoxemia&#41;&#44; leading to insulin resistance&#44; adipose tissue inflammation&#44; and tissue infiltration of monocytes&#47;macrophages&#44; which increase the risk of diseases such as hepatic steatosis&#44; obesity&#44; and diabetes&#46; Thus&#44; part of the systemic inflammatory response can be attributed to the composition of IM&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">In a murine model of imiquimod-induced psoriasis&#44; oral administration of <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Streptococcus danieliae</span> led to skin inflammation and increased expression of TNF&#44; and IL-17&#44; supporting the hypothesis that intestinal dysbiosis may lead to clinical worsening of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">This study originally investigated associations between plasma levels of LPB&#44; hs-CRPqt&#44; and dietary patterns in omnivores&#44; vegetarians&#44; and patients with psoriasis&#44; demonstrating that LPB levels were inversely correlated with fiber intake&#46; In this sample&#44; participants with psoriasis had higher LPB levels than vegetarians&#44; leading to the hypothesis that IM modulation &#40;e&#46;g&#46;&#44; through diet&#41; contributes to reduction in serum LPB levels&#46; Therefore&#44; these findings support that intestinal health can be modulated through food choices&#46; Moreover&#44; hs-CRPqt levels were higher in the PSO group&#44; associated with carbohydrate intake and LPB levels&#46; Although intestinal permeability is not directly assessed&#44; elevated LPB and hs-CRPqt levels may indicate increased intestinal permeability in patients with psoriasis&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Studies with serum levels of LPB in humans are scarce&#44; but there is evidence that LPB is elevated in patients with psoriasis&#44; and correlate with the levels of hs-CRPqt&#46; Thus&#44; LPB may be an indicator of systemic inflammation and progression to metabolic syndrome in patients with psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It is noteworthy that LPB has recently been shown to be a biomarker for intestinal permeability in adults&#44; regardless of age&#44; BMI&#44; and sex&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Different findings were obtained in controlled studies that analyzed the IM of patients with psoriasis using different population groups&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In an Israeli study that evaluated beta diversity in patients with psoriasis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#44; when compared to controls &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41; without psoriasis&#44; matched by age&#44; BMI&#44; and comorbidities&#44; a significant increase was identified in <span class="elsevierStyleItalic">Ruminococcus gnavus</span>&#44; <span class="elsevierStyleItalic">Dorea formicigenerans</span> and <span class="elsevierStyleItalic">Collinsella aerofaciens</span> in the IM of patients with psoriasis&#44; while <span class="elsevierStyleItalic">Prevotella copri</span> and <span class="elsevierStyleItalic">Parabacteroides distasonis</span> were significantly lower when compared to controls&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> This constitutes a somewhat different pattern than the IM composition found in the present sample&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Another study performed in China showed that patients with psoriasis have significantly disordered IM profiles&#44; because when analyzing the IM of 35 patients with psoriasis and 27 controls&#44; a difference was observed regarding the relative abundance of <span class="elsevierStyleItalic">Firmicutes</span> and <span class="elsevierStyleItalic">Bacteroidetes</span>&#44; with an increase in <span class="elsevierStyleItalic">Bacteroides</span>&#44; <span class="elsevierStyleItalic">Actinobacteria</span> and a decrease in <span class="elsevierStyleItalic">Firmicutes</span>&#44; <span class="elsevierStyleItalic">Proteobacteria</span>&#44; and <span class="elsevierStyleItalic">Bifidobacterium</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> In contrast&#44; another study of patients with psoriasis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&#44; compared with a healthy control group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41; conducted in Spain&#44; showed lower bacterial diversity and different relative abundance of certain bacterial taxa in patients with psoriasis&#44; with an increase in <span class="elsevierStyleItalic">Actinobacteria</span>&#44; <span class="elsevierStyleItalic">Firmicutes</span>&#44; and a decrease in <span class="elsevierStyleItalic">Bacteroidetes</span>&#44; <span class="elsevierStyleItalic">Proteobacteria</span>&#44; <span class="elsevierStyleItalic">Faecalibacterium</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">In an IM analysis of 52 patients with psoriasis &#40;PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; compared to a healthy population &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>300&#41;&#44; a higher frequency of the pattern called enterotype 2 was evidenced&#44; with a tendency to show more frequent bacterial translocation and greater inflammatory status &#40;71&#37;&#41; than other enterotypes&#44; with a predominance of <span class="elsevierStyleItalic">Akkermansia</span>&#44; <span class="elsevierStyleItalic">Faecalibacterium</span>&#44; <span class="elsevierStyleItalic">Ruminococcus</span> and a lower proportion of <span class="elsevierStyleItalic">Bacteroidetes</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The present sample also indicated higher proportions of <span class="elsevierStyleItalic">Faecalibacterium</span> and <span class="elsevierStyleItalic">Ruminococcus</span>&#44; in addition to lower levels of <span class="elsevierStyleItalic">Bacteroidetes</span> in the profile &#40;PLS&#41; of patients with psoriasis&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Recently&#44; a study conducted in Argentina demonstrated changes in IM composition depending on psoriasis status&#44; with increased <span class="elsevierStyleItalic">Firmicutes</span> and depletion of <span class="elsevierStyleItalic">Bacteroidetes</span> in 55 patients with psoriasis when compared to 27 controls&#46; Additionally&#44; the <span class="elsevierStyleItalic">Faecalibacterium</span> and <span class="elsevierStyleItalic">Blautia</span> genera were higher in patients with psoriasis&#44; while <span class="elsevierStyleItalic">Bacteroides</span> and <span class="elsevierStyleItalic">Paraprevotella</span> were higher in controls without psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Since the patients in the present study were undergoing treatment&#44; and most of them had PASI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#44; it was not possible to stratify the IM according to disease severity&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Another case-control study in Central Asia&#44; with patients aged between 30 and 45 years&#44; with psoriasis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41; and controls &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; matched for age and sex&#44; found an association between psoriasis and elevated levels of <span class="elsevierStyleItalic">Firmicutes</span>&#44; <span class="elsevierStyleItalic">Faecalibacterium</span> and reduced abundance of <span class="elsevierStyleItalic">Oscillibacter</span> and <span class="elsevierStyleItalic">Roseburia</span>&#44; but there was no difference regarding diversity and the F&#47;B ratio&#44; very much in line with the results of the present study&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">A Brazilian study showed less diversity in the IM of women with psoriasis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41; when compared to controls &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#44; identifying an increase in the <span class="elsevierStyleItalic">Dialister</span> genus and the <span class="elsevierStyleItalic">Prevotella copri</span> sp&#46;&#44; with a reduction in <span class="elsevierStyleItalic">Ruminococcus</span>&#44; <span class="elsevierStyleItalic">Lachnospira</span>&#44; and <span class="elsevierStyleItalic">Blautia</span> genera&#44; and <span class="elsevierStyleItalic">Akkermansia muciniphila</span> sp&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">In the present study&#44; the IM profile found in adult men with psoriasis was associated with those described in other comorbidities&#44; such as metabolic syndrome&#44; obesity&#44; and affective diseases&#44; which may be due to the Western lifestyle&#46; Also according to the literature&#44; <span class="elsevierStyleItalic">Coprococcus</span> was associated with affective diseases such as depression&#44; obesity&#44; and poor sleep quality<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#59; <span class="elsevierStyleItalic">Lachnospira</span> was associated with the development of diabetes mellitus and <span class="elsevierStyleItalic">Paraprevotella</span> with higher fat intake&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">33</span></a> Although there is an association with vegetarian diets&#44; <span class="elsevierStyleItalic">Prevotella</span> is also associated with high carbohydrate intake&#44; and as it has high genetic diversity within and between species&#44; this may explain its description in healthy individuals IM and in those with dysbiosis&#59; and a high load of <span class="elsevierStyleItalic">Prevotella</span> in IM has been associated with obesity&#44; insulin resistance&#44; hypertension&#44; and non-alcoholic fatty liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">34</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">The composition of IM in patients with psoriasis found in the present sample was opposed to that found in vegetarians&#44; rich in <span class="elsevierStyleItalic">Bacteroides</span> and <span class="elsevierStyleItalic">Lactobacillus</span>&#44; associated with lower intestinal permeability&#46; In fact&#44; the prevalence of psoriasis in vegetarians is rare&#44; and the vegetarian diet leads to improvement in psoriatic skin lesions&#44; suggesting that IM modulation may support the development of inflammatory diseases such as psoriasis&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">35&#44;36</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Metagenomic studies of IM show high variability of results&#46; Ethnic&#44; cultural&#44; and dietary differences between populations may explain the controversial results of studies that characterized IM in patients with psoriasis&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Thus&#44; what constitutes a healthy IM has yet to be defined&#44; after excluding known pathogenic bacteria&#46; Therefore&#44; it is essential to emphasize that commensal species should not be considered absolutely &#8220;good&#8221; or &#8220;bad&#8221; since they all play a role in the intestinal ecosystem&#46; The problem emerges from the imbalance&#44; that is&#44; the predominance of groups of commensal species that promote changes in intestinal permeability&#46; Moreover&#44; when characterizing the IM of a group&#44; the aim is to understand the imbalance pattern&#44; although the IM composition is unique in each individual&#44; is acquired in the first years of life and shaped by environmental characteristics&#44; such as eating habits&#44; throughout life&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">37&#8211;39</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">The present study has limitations related to the modest&#44; non-randomized sample&#44; which did not prevent the identification of IM patterns among the groups studied&#46; Moreover&#44; the common origin of the population group maximizes sample homogeneity&#46; The effect of psoriasis treatments on IM is a topic to be investigated and the participants used several different drugs&#59; however&#44; the use of adalimumab was not shown to modify the IM pattern in ten patients&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">40</span></a> The participants of the present study also had low PASI scores&#44; due to disease control with the established therapy&#46; In fact&#44; IM studies with patients with psoriasis without systemic treatment are needed&#46; Another aspect refers to the sampling of the fecal microbiome&#44; which consists of the transient flora of the colon&#44; in contrast to the permanent flora that is related to the mucosa&#44; less subject to variation&#46; Finally&#44; LPB is used as a proxy for LPS measurement&#44; due to its lability&#46; Dietary variations can make comparisons among groups difficult since even among the omnivore&#44; vegetarian&#44; and psoriasis groups&#44; there are foods that can act differently on the IM&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Controlled clinical studies in psoriasis aimed at manipulating the IM&#44; whether with stool transplantation&#44; dietary interventions &#40;e&#46;g&#46;&#44; fiber intake adequacy&#41;&#44; pro&#47;prebiotics&#44; or bile salts&#44; must be carried out to better understand the role of the IM in the clinical activity of psoriasis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0280" class="elsevierStylePara elsevierViewall">A difference was identified in the IM of Brazilian adult men with psoriasis&#44; in comparison to healthy omnivores and vegetarian controls&#46; The identified IM pattern correlated with dietary fiber intake and LPB serum levels&#46; Changes in eating habits can remodel IM&#44; and consequently help in the clinical control of psoriasis&#46; The present study emphasizes the need to raise awareness of the nutritional importance in the treatment of the disease and the management of comorbidities&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Financial support</span><p id="par0285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs0005">FUNADERM</span> - Fundo de Apoio &#224; Dermatologia&#44; da Sociedade Brasileira de Dermatologia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Authors&#39; contributions</span><p id="par0290" class="elsevierStylePara elsevierViewall">H&#233;lio Amante Miot&#58; Design of the study&#59; analysis of results&#59; drafting of the manuscript&#59; review and approval of the final version of the manuscript&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Tatiana Cristina Figueira Polo&#58; Design of the study&#59; collection of data&#59; analysis of results&#59; drafting of the manuscript&#59; review and approval of the final version of the manuscript&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Mariana Righetto de R&#233; Lai&#58; Design of the study&#59; data collection&#59; analysis of results&#59; drafting of the manuscript&#59; review and approval of the final version of the manuscript&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Luciane Donida Bartoli Miot&#58; Data collection&#59; review and approval of the final version of the manuscript&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Giovana Fernanda Cosi Bento&#58; Analysis of results&#59; review and approval of the final version of the manuscript&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">M&#225;rcia Guimar&#227;es da Silva&#58; Review and approval of the final version of the manuscript&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Silvio Alencar Marques&#58; Review and approval of the final version of the manuscript&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0325" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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            0 => "Diet"
            1 => "Western diet"
            2 => "Gastrointestinal microbiome"
            3 => "Microbiota"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Psoriasis is a chronic inflammatory disease associated with systemic inflammation and comorbidities&#46; Changes in the composition of the intestinal microbiome are involved in the pathogenesis of inflammatory diseases and metabolic syndrome&#46; Characterizing the intestinal microbiome of patients with psoriasis may be relevant for the understanding of its clinical course and comorbidity prevention&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To characterize the intestinal microbiome of men with psoriasis compared to omnivore and vegetarian controls &#40;without psoriasis&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Method</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study of 42 adult males&#58; 21 omnivores with psoriasis&#59; and controls&#58; 14 omnivores and 7 vegetarian individuals&#46; The characterization of the intestinal microbiome was performed by metagenomic analysis&#46; Serum levels of lipopolysaccharide-binding protein &#40;LPB&#41; and C-reactive protein &#40;CRP&#41; were evaluated&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The groups differed from each other regarding nutritional aspects and microbiome&#59; individuals with psoriasis had a higher consumption of protein and lower consumption of fibers&#46; Levels of LPB&#44; CRP&#44; and the <span class="elsevierStyleItalic">Firmicutes&#47;Bacteroidetes</span> ratio were higher in the group with psoriasis than in the vegetarian group &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The genera <span class="elsevierStyleItalic">Prevotella</span>&#44; <span class="elsevierStyleItalic">Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Dorea</span>&#44; <span class="elsevierStyleItalic">Bifidobacterium</span> and <span class="elsevierStyleItalic">Coprococcus</span>&#44; differed in the group with psoriasis compared to vegetarians&#59; the genera <span class="elsevierStyleItalic">Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Collinsella</span> and <span class="elsevierStyleItalic">Desulfovibrio</span> differed from omnivores&#46; A microbiome pattern linked to psoriasis &#40;plsPSO&#41; was identified&#44; which was associated with higher LPB levels &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;39&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#44; and lower dietary fiber intake &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;71&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Study limitations</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Only adult men were evaluated&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A difference was identified in the intestinal microbiome of adult men with psoriasis when compared to healthy omnivores and vegetarian controls&#46; The identified microbiome pattern was correlated with dietary fiber intake and serum levels of LPB&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Loading of participants according to PLS components &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&#46; Compositions that discriminate the groups are highlighted&#46; PLS&#44; Partial Least Squares Component&#59; OMNI&#44; Omnivore Controls&#59; VEG&#44; Vegetarian Controls&#59; PSO&#44; Psoriasis</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Heat map with bivariate correlations among levels of LPB&#44; CRP&#44; nutritional characteristics of the diet and intestinal microbiome pattern of patients with psoriasis&#46; LPB&#44; Lipopolysaccharide binding protein serum level&#59; hs-CRPqt&#44; highly-sensitive C-reactive protein serum level &#40;quantitative test&#41;&#59; CHg&#44; Carbohydrates &#40;in grams&#41;&#59; PRg&#44; Proteins &#40;in grams&#41;&#59; LIPg&#44; Lipids &#40;in grams&#41;&#59; FIBg&#44; Fibers &#40;in grams&#41;&#59; plsPSO&#44; PLS component of the intestinal microbiome of participants with psoriasis</p>"
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                  \t\t\t\t">466&#46;9 &#40;86&#46;8&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">LPB &#40;mg&#47;mL&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;6 &#40;2&#46;9&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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