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Cited by 128Psoriasis: Treatment and PathogenesisDermatology and Skin DiseasesSpondyloarthritis Studies and Treatments

A review of the mechanisms of action of dimethylfumarate in the treatment of psoriasis

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Brück, Jürgen, Dringen, Ralf, Amasuno, Adriana, Pau‐Charles, Ignasi, Ghoreschi, Kamran·2018·Experimental Dermatology
DOI 10.1111/exd.13548
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Abstract

Fumaric acid esters (FAEs) such as dimethylfumarate (DMF) are used for the treatment of adults with moderate‐to‐severe psoriasis. The mode of action of FAEs is complex. Here, we provide a comprehensive review of the literature to describe the molecular mechanisms by which DMF and its active metabolite monomethylfumarate (MMF) exert their anti‐inflammatory and immune modulatory effects. MMF can bind to the hydroxy‐carboxylic acid receptor 2 (HCA2) on the cell surface and both DMF and MMF react with intracellular glutathione following cell penetration. DMF and to some extent also MMF modulate the activity of certain cellular signalling proteins such as the nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2), nuclear factor kappa B (Nf‐κB) and the cellular concentration of cyclic adenosine monophosphate. Some studies show that DMF can also affect the hypoxia‐inducible factor 1‐alpha (HIF‐1α). These actions seem to be responsible for i) the downregulation of inflammatory cytokines and ii) an overall shift from a proinflammatory Th1/Th17 response to an anti‐inflammatory/regulatory Th2 response. Both steps are necessary for the amelioration of psoriatic inflammation, although additional mechanisms have been proposed. There is a growing body of evidence to support the notion that DMF/MMF may also exert effects on granulocytes and non‐immune cell lineages including keratinocytes and endothelial cells. A better understanding of the multiple molecular mechanisms involved in the cellular action of FAEs will help to adapt and further improve the use of such small molecules for the treatment of psoriasis and other chronic inflammatory diseases.

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  • Fumarate causes HIF stabilisation even under normoxic conditions (pseudohypoxia), a hallmark of FH-deficient tumours.

    “Accordingly, fumarate causes HIF stabilisation, even under normoxic conditions, i.e. pseudohypoxia, a hallmark of FH-deficient tumours93.”

    From Coupling Krebs cycle metabolites to signalling in immunity and cancer (2018) · cites this paper as [93]

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Authors
Brück, J., Dringen, R., Amasuno, A., Pau‐Charles, I., & Ghoreschi, K.
Affiliations
  • University of Tübingen (DE)
  • University of Bremen (DE)
  • Almirall (Spain) (ES)
Corresponding author
Ghoreschi, Kamran
ORCID
Venue
Experimental Dermatology
Publisher
Wiley
Published
2018-04-25
Volume
27
Issue
6
Pages
611-624
ISSN
  • 0906-6705 (ISSN-L)
  • 1600-0625
DOI
10.1111/exd.13548
OpenAlex
W2795256497
Cited by
128
References
172
Citations by year
2026: 12 · 2025: 18 · 2024: 7 · 2023: 13 · 2022: 20 · 2021: 25 · 2020: 21 · 2019: 9 · 2018: 3
FWCI
1.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Experimental Dermatology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Deutsche Forschungsgemeinschaft (Sonderforschungsbereich (SFB) TR‐156, TP A06)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Rheumatology › Spondyloarthritis Studies and Treatments
Keywords
dimethyl fumarate, fumaric acid esters, psoriasis, glutathione, Nrf2, NF-κB, HIF-1α, Th2 immune response, inflammatory cytokines, granulocytes, keratinocytes, endothelial cells, anti-inflammatory mechanism, immunomodulation
MeSH terms
Dimethyl Fumarate, Animals, Dermatologic Agents, Glutathione, Humans, Lymphocytes, Neutrophils, Psoriasis, Signal Transduction, Down-Regulation, Keratinocytes, Cytokines, NF-kappa B, Endothelial Cells, Receptors, G-Protein-Coupled, NF-E2-Related Factor 2

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