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In the skin and serum of patients with psoriasis vulgaris, increased expression of HIF-1\u03b1 has been reported, whereas HIF-1\u03b1 expression in the skin and serum of patients with hidradenitis suppurativa (HS) has not yet been studied. The objective of the study is to demonstrate is there a role for HIF-1\u03b1 in the pathogenesis of hidradenitis suppurativa, and its relation to HS severity. Twenty patients suffering from hidradenitis suppurativa were included in the study. Punch biopsies were taken from lesional skin for the determination of HIF-1\u03b1 expression by immunohistochemical staining, and HIF-1\u03b1 gene expression by quantitative reverse transcription real time PCR. Quantification of HIF-1\u03b1 protein concentration was done by enzyme-linked immunosorbent assay. Twenty socio-demographically cross-matched healthy volunteers served as controls. We found increased serum levels of HIF-1\u03b1. Literature-derived evidence indicates that the major clinical triggering factors of HS, obesity, and smoking are associated with hypoxia and enhanced HIF-1\u03b1 expression. Pro-inflammatory cytokines such as tumor necrosis factor-<jats:inline-formula><jats:alternatives><jats:tex-math>$$a$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mi>a<\/mml:mi>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula> via upregulation of nuclear factor <jats:inline-formula><jats:alternatives><jats:tex-math>$$\\kappa$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mi>\u03ba<\/mml:mi>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula>B enhance HIF-1\u03b1 expression. HIF-1\u03b1 plays an important role for keratinocyte proliferation, especially for keratinocytes of the anagen hair follicle, which requires abundant glycolysis providing sufficient precursors molecules for biosynthetic pathways. Metformin via inhibition of mTORC1 as well as adalimumab attenuate HIF-1\u03b1 expression, the key mediator between Th17-driven deviated immunity and keratinocyte hyperproliferation. In accordance with psoriasis, our study identifies HS as an HIF-1\u03b1-driven inflammatory skin disease and offers a new rationale for the prevention and treatment of HS by targeting HIF-1<jats:inline-formula><jats:alternatives><jats:tex-math>$$a$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mi>a<\/mml:mi>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula> overexpression.<\/jats:p>","DOI":"10.1007\/s00403-023-02594-6","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T06:03:55Z","timestamp":1679637835000},"page":"2107-2118","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Overexpression of hypoxia-inducible factor-1\u03b1 in hidradenitis suppurativa: the link between deviated immunity and metabolism"],"prefix":"10.1007","volume":"315","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0200-3390","authenticated-orcid":false,"given":"Naglaa Fathi","family":"Agamia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osama Ahmed","family":"Sorror","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naglaa Mohamed","family":"Sayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rasha Abdelmawla","family":"Ghazala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sammar Mohamed","family":"Echy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doaa Helmy","family":"Moussa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bodo Clemens","family":"Melnik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"2594_CR1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/der2.113","volume":"3","author":"EK Kozera","year":"2022","unstructured":"Kozera EK, Frew JW (2022) The pathogenesis of hidradenitis suppurativa: evolving paradigms in a complex disease. 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