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Guo H, Cheng Y, Shapiro J, McElwee K. The role of lymphocytes in the development and treatment of alopecia areata. Expert Rev Clin Immunol 2015; 11:1335-51. [PMID: 26548356 DOI: 10.1586/1744666x.2015.1085306] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Alopecia areata (AA) development is associated with both innate and adaptive immune cell activation, migration to peri- and intra-follicular regions, and hair follicle disruption. Both CD4(+) and CD8(+) lymphocytes are abundant in AA lesions; however, CD8(+) cytotoxic T lymphocytes are more likely to enter inside hair follicles, circumstantially suggesting that they have a significant role to play in AA development. Several rodent models recapitulate important features of the human autoimmune disease and demonstrate that CD8(+) cytotoxic T lymphocytes are fundamentally required for AA induction and perpetuation. However, the initiating events, the self-antigens involved, and the molecular signaling pathways, all need further exploration. Studying CD8(+) cytotoxic T lymphocytes and their fate decisions in AA development may reveal new and improved treatment approaches.
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Affiliation(s)
- Hongwei Guo
- a 1 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,b 2 Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Yabin Cheng
- a 1 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jerry Shapiro
- a 1 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,c 3 Department of Dermatology, New York University, Langone Medical Center, New York, USA
| | - Kevin McElwee
- a 1 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,d 4 Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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52
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Dobreva A, Paus R, Cogan N. Mathematical model for alopecia areata. J Theor Biol 2015; 380:332-45. [DOI: 10.1016/j.jtbi.2015.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 05/14/2015] [Accepted: 05/21/2015] [Indexed: 11/16/2022]
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Ali N, Hosseini M, Vainio S, Taïeb A, Cario‐André M, Rezvani H. Skin equivalents: skin from reconstructions as models to study skin development and diseases. Br J Dermatol 2015; 173:391-403. [DOI: 10.1111/bjd.13886] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 12/17/2022]
Affiliation(s)
- N. Ali
- Laboratory of Developmental Biology Faculty of Biochemistry and Molecular Medicine University of Oulu and Biocenter Oulu Aapistie 5A 90220 Oulu Finland
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
| | - M. Hosseini
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
| | - S. Vainio
- Laboratory of Developmental Biology Faculty of Biochemistry and Molecular Medicine University of Oulu and Biocenter Oulu Aapistie 5A 90220 Oulu Finland
| | - A. Taïeb
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
- Centre de Référence pour les Maladies Rares de la Peau Bordeaux France
- Département de Dermatologie & Dermatologie Pédiatrique CHU de Bordeaux Bordeaux France
| | - M. Cario‐André
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
- Centre de Référence pour les Maladies Rares de la Peau Bordeaux France
| | - H.R. Rezvani
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
- Centre de Référence pour les Maladies Rares de la Peau Bordeaux France
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Han YM, Sheng YY, Xu F, Qi SS, Liu XJ, Hu RM, Miao Y, Huang GQ, Yang QP. Imbalance of T-helper 17 and regulatory T cells in patients with alopecia areata. J Dermatol 2015; 42:981-8. [PMID: 26077574 DOI: 10.1111/1346-8138.12978] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 05/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Yu-Mei Han
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - You-Yu Sheng
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - Feng Xu
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - Si-Si Qi
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - Xiao-Jing Liu
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - Rui-Ming Hu
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - Ying Miao
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - Gui-Qin Huang
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - Qin-Ping Yang
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
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Li Y, Yan B, Wang H, Li H, Li Q, Zhao D, Chen Y, Zhang Y, Li W, Zhang J, Wang S, Shen J, Li Y, Guindi E, Zhao Y. Hair regrowth in alopecia areata patients following Stem Cell Educator therapy. BMC Med 2015; 13:87. [PMID: 25896390 PMCID: PMC4417286 DOI: 10.1186/s12916-015-0331-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/17/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Alopecia areata (AA) is one of the most common autoimmune diseases and targets the hair follicles, with high impact on the quality of life and self-esteem of patients due to hair loss. Clinical management and outcomes are challenged by current limited immunosuppressive and immunomodulating regimens. METHODS We have developed a Stem Cell Educator therapy in which a patient's blood is circulated through a closed-loop system that separates mononuclear cells from the whole blood, allows the cells to briefly interact with adherent human cord blood-derived multipotent stem cells (CB-SC), and returns the "educated" autologous cells to the patient's circulation. In an open-label, phase 1/phase 2 study, patients (N = 9) with severe AA received one treatment with the Stem Cell Educator therapy. The median age was 20 years (median alopecic duration, 5 years). RESULTS Clinical data demonstrated that patients with severe AA achieved improved hair regrowth and quality of life after receiving Stem Cell Educator therapy. Flow cytometry revealed the up-regulation of Th2 cytokines and restoration of balancing Th1/Th2/Th3 cytokine production in the peripheral blood of AA subjects. Immunohistochemistry indicated the formation of a "ring of transforming growth factor beta 1 (TGF-β1)" around the hair follicles, leading to the restoration of immune privilege of hair follicles and the protection of newly generated hair follicles against autoimmune destruction. Mechanistic studies revealed that co-culture with CB-SC may up-regulate the expression of coinhibitory molecules B and T lymphocyte attenuator (BTLA) and programmed death-1 receptor (PD-1) on CD8β(+)NKG2D(+) effector T cells and suppress their proliferation via herpesvirus entry mediator (HVEM) ligands and programmed death-1 ligand (PD-L1) on CB-SCs. CONCLUSIONS Current clinical data demonstrated the safety and efficacy of the Stem Cell Educator therapy for the treatment of AA. This innovative approach produced lasting improvement in hair regrowth in subjects with moderate or severe AA. TRIAL REGISTRATION ClinicalTrials.gov, NCT01673789, 21 August 2012.
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Affiliation(s)
- Yanjia Li
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Baoyong Yan
- Cell Therapy Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Hepeng Wang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Heng Li
- Department of Neurology, Jinan Central Hospital, Shandong University, Jinan, Shandong, 250013, P.R. China.
| | - Quanhai Li
- Cell Therapy Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Dong Zhao
- Department of Pathology, Jinan Central Hospital, Shandong University, Jinan, Shandong, 250013, P.R. China.
| | - Yana Chen
- Department of Obstetrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, 250013, P.R. China.
| | - Ye Zhang
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Wenxia Li
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Jun Zhang
- Cell Therapy Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Shanfeng Wang
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Jie Shen
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Yunxiang Li
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | | | - Yong Zhao
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China. .,Department of Research, Hackensack University Medical Center, 40 Prospect Avenue, Hackensack, NJ, 07601, USA.
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Yamakita T, Shimizu Y, Arima M, Ashihara M, Matsunaga K. Successful treatment of multiplex alopecia areata using transactional analysis: a case report. Case Rep Dermatol 2014; 6:248-52. [PMID: 25493080 PMCID: PMC4255999 DOI: 10.1159/000368821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The patient was a 13-year-old female. Six years previously, she developed alopecia areata when her parents divorced. One year after that, the bald area drastically expanded when her mother remarried. She was treated at her local hospital; however, no improvement was observed. She then visited our hospital for examination. A bald patch was covering >80% of her head. Self Grow-Up Egogram indicated the basic interpersonal relationship stance of ‘I am not OK, You are OK’. We therefore implemented a transactional analysis approach to increase the patient's score on the Free Child subscale. New hair growth was observed after 6 months and the bald patch disappeared after 2 years. Our results suggest that this method could also be easily applied in a clinical setting by dermatologists.
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Affiliation(s)
- Takashi Yamakita
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshinori Shimizu
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaru Arima
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mutsumi Ashihara
- Department of Psychosomatic Medicine, Chubu Rosai Hospital, Nagoya, Japan
| | - Kayoko Matsunaga
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
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Abstract
Alopecia areata is a complex genetic, immune-mediated disease that targets anagen hair follicles. The disease affects children and adults and is characterized by round or oval patches of hair loss, loss of all scalp hair (alopecia totalis), body hair (alopecia universalis), or ophiasis pattern hair loss. Patients may also present with patchy loss in multiple hair-bearing areas. Commonly associated diseases include asthma, allergic rhinitis, atopic dermatitis, thyroid disease, and automimmune diseases, such as thyroiditis and vitiligo. Nail abnormalities may precede, follow, or occur concurrently with hair loss activity. Alopecia areata has no known age, race, or ethnic preponderance and in contrast to other autoimmune diseases such as thyroiditis or lupus, the hair follicle does not usually sustain permanent injury and maintains its potential to regrow hair. It is estimated that alopecia areata affects between six and seven million individuals in the United States. Genes, the immune and nervous systems have all been implicated in the pathogenesis of alopecia areata. Although many treatments are available, there is still no cure. Bolstered by new scientific and translational opportunities from recently published genome-wide association studies, an ambitious treatment development program has recently been initiated by the National Alopecia Areata Foundation.
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Affiliation(s)
- Maria K Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
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58
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Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, de Jong A, Harel S, DeStefano GM, Rothman L, Singh P, Petukhova L, Mackay-Wiggan J, Christiano AM, Clynes R. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med 2014; 20:1043-9. [PMID: 25129481 PMCID: PMC4362521 DOI: 10.1038/nm.3645] [Citation(s) in RCA: 609] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 06/30/2014] [Indexed: 12/12/2022]
Abstract
Alopecia areata (AA) is a common autoimmune disease resulting from damage of the hair follicle by T cells. The immune pathways required for autoreactive T cell activation in AA are not defined limiting clinical development of rational targeted therapies. Genome-wide association studies (GWAS) implicated ligands for the NKG2D receptor (product of the KLRK1 gene) in disease pathogenesis. Here, we show that cytotoxic CD8(+)NKG2D(+) T cells are both necessary and sufficient for the induction of AA in mouse models of disease. Global transcriptional profiling of mouse and human AA skin revealed gene expression signatures indicative of cytotoxic T cell infiltration, an interferon-γ (IFN-γ) response and upregulation of several γ-chain (γc) cytokines known to promote the activation and survival of IFN-γ-producing CD8(+)NKG2D(+) effector T cells. Therapeutically, antibody-mediated blockade of IFN-γ, interleukin-2 (IL-2) or interleukin-15 receptor β (IL-15Rβ) prevented disease development, reducing the accumulation of CD8(+)NKG2D(+) T cells in the skin and the dermal IFN response in a mouse model of AA. Systemically administered pharmacological inhibitors of Janus kinase (JAK) family protein tyrosine kinases, downstream effectors of the IFN-γ and γc cytokine receptors, eliminated the IFN signature and prevented the development of AA, while topical administration promoted hair regrowth and reversed established disease. Notably, three patients treated with oral ruxolitinib, an inhibitor of JAK1 and JAK2, achieved near-complete hair regrowth within 5 months of treatment, suggesting the potential clinical utility of JAK inhibition in human AA.
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Affiliation(s)
- Luzhou Xing
- 1] Department of Pathology, Columbia University, New York, New York, USA. [2]
| | - Zhenpeng Dai
- 1] Department of Dermatology, Columbia University, New York, New York, USA. [2]
| | - Ali Jabbari
- 1] Department of Dermatology, Columbia University, New York, New York, USA. [2]
| | - Jane E Cerise
- 1] Department of Dermatology, Columbia University, New York, New York, USA. [2] Department of Psychiatry, Columbia University, New York, New York, USA
| | - Claire A Higgins
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Weijuan Gong
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Annemieke de Jong
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Sivan Harel
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Gina M DeStefano
- 1] Department of Dermatology, Columbia University, New York, New York, USA. [2] Department of Epidemiology, Columbia University, New York, New York, USA
| | - Lisa Rothman
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Pallavi Singh
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Lynn Petukhova
- Department of Dermatology, Columbia University, New York, New York, USA
| | | | - Angela M Christiano
- 1] Department of Dermatology, Columbia University, New York, New York, USA. [2] Department of Genetics and Development, Columbia University, New York, New York, USA. [3]
| | - Raphael Clynes
- 1] Department of Pathology, Columbia University, New York, New York, USA. [2] Department of Dermatology, Columbia University, New York, New York, USA. [3] Department of Medicine, Columbia University, New York, New York, USA. [4]
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Marwah M, Nadkarni N, Patil S. 'Ho-ver'ing Over Alopecia Areata: Histopathological Study of 50 Cases. Int J Trichology 2014; 6:13-8. [PMID: 25114447 PMCID: PMC4124686 DOI: 10.4103/0974-7753.136749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Different studies have been done on this topic, most of the older studies on the vertical section confirm that peribulbar infiltrate is an important finding, however the newer studies on the horizontal section, mention decreased anagen to telogen ratio, decreased terminal to vellus hair ratio and a decreased follicular count. These studies on horizontal (transverse sections) have shown that transverse sectioning is superior and more diagnostic in studying alopecias. However, these studies are based on multiple cut sections, because in a single cut section, we may miss a few hair bulbs above or below, depending on where the section is taken. Hence this makes it a time consuming, technically challenging and expensive procedure. OBJECTIVES 1. To compare the histopathological features of single vertical section versus a single horizontal section cut in the reticular dermis. 2. To determine if a single horizontal section is sufficient to report a biopsy of alopecia areata compared to multiple sections. MATERIALS AND METHODS To compare the findings, in 50 patients with localized alopecia areata, 25 sectioned horizontally and 25 vertically, single section. Only three of the common findings, peribulbar infiltrate, intrabulbar infiltrate and perifollicular microscarring was considered and reported. RESULTS Once the anagen to telogen ratio is excluded from the comparison, diagnosis made on the basis of a single horizontal section is considered sufficient to give us an aid toward the prognosis.
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Affiliation(s)
- Manjot Marwah
- Department of Dermatology, National Hair Clinic, Hamirpur, Himachal Pradesh, India
| | - Nitin Nadkarni
- Department of Dermatology, Dr. D.Y. Patil Medical College and Research Centre, Mumbai, Maharashtra, India
| | - Sharmila Patil
- Department of Dermatology, Dr. D.Y. Patil Medical College and Research Centre, Mumbai, Maharashtra, India
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Bakry OA, El Shazly RMA, Basha MA, Mostafa H. Total serum immunoglobulin E in patients with alopecia areata. Indian Dermatol Online J 2014; 5:122-7. [PMID: 24860742 PMCID: PMC4030335 DOI: 10.4103/2229-5178.131076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context: Alopecia areata (AA) is a common form of localized, non-scarring hair loss. The pathogenesis of the disease is unknown. Previous evidence suggested the involvement of Th2 cytokines in disease pathogenesis. Aim: To determine serum level of total IgE, this is mainly influenced by Th2 cytokines, in Egyptian patients with AA. Materials and Methods: Fifty subjects with AA (28 males and 22 females) were selected from Dermatology Outpatient Clinic, Menoufiya University Hospital from February 2012 to December 2012. Subjects with other conditions that might elevate serum IgE were excluded from the study. Fifty age- and sex-matched healthy subjects were selected as a control group. Venous blood samples were taken from cases and controls for measurement of total serum IgE by enzyme-linked immunosorbent assay. Skin biopsy was taken from every case from an active area of hair loss. Results: Total serum IgE was elevated in 27 (54%) cases. Its values among patients ranged from 13.5 IU/ml to 780 IU/ml. There was a statistically significant difference between cases and controls with regard to mean value of serum IgE (P < 0.05). Mean value of IgE did not vary significantly with disease severity, patients’ age, patients’ gender, disease duration, site of lesions, and positive family history of AA. No correlation was found between serum IgE levels and histopathological changes detected in examined cases. Conclusions: Total serum IgE is elevated in AA. This elevation is not related to age, gender, disease duration, disease severity, site of affection or family history of AA.
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Affiliation(s)
- Ola Ahmed Bakry
- Departments of Dermatology, Andrology and STDs, Menoufiya University, Menoufiya, Egypt
| | | | - Mohamed Ahmed Basha
- Departments of Dermatology, Andrology and STDs, Menoufiya University, Menoufiya, Egypt
| | - Hanan Mostafa
- Departments of Dermatology, Andrology and STDs, Menoufiya University, Menoufiya, Egypt
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Bertolini M, Zilio F, Rossi A, Kleditzsch P, Emelianov VE, Gilhar A, Keren A, Meyer KC, Wang E, Funk W, McElwee K, Paus R. Abnormal interactions between perifollicular mast cells and CD8+ T-cells may contribute to the pathogenesis of alopecia areata. PLoS One 2014; 9:e94260. [PMID: 24832234 PMCID: PMC4022513 DOI: 10.1371/journal.pone.0094260] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/12/2014] [Indexed: 02/08/2023] Open
Abstract
Alopecia areata (AA) is a CD8+ T-cell dependent autoimmune disease of the hair follicle (HF) in which the collapse of HF immune privilege (IP) plays a key role. Mast cells (MCs) are crucial immunomodulatory cells implicated in the regulation of T cell-dependent immunity, IP, and hair growth. Therefore, we explored the role of MCs in AA pathogenesis, focusing on MC interactions with CD8+ T-cells in vivo, in both human and mouse skin with AA lesions. Quantitative (immuno-)histomorphometry revealed that the number, degranulation and proliferation of perifollicular MCs are significantly increased in human AA lesions compared to healthy or non-lesional control skin, most prominently in subacute AA. In AA patients, perifollicular MCs showed decreased TGFβ1 and IL-10 but increased tryptase immunoreactivity, suggesting that MCs switch from an immuno-inhibitory to a pro-inflammatory phenotype. This concept was supported by a decreased number of IL-10+ and PD-L1+ MCs, while OX40L+, CD30L+, 4–1BBL+ or ICAM-1+ MCs were increased in AA. Lesional AA-HFs also displayed significantly more peri- and intrafollicular- CD8+ T-cells as well as more physical MC/CD8+ T-cell contacts than healthy or non-lesional human control skin. During the interaction with CD8+ T-cells, AA MCs prominently expressed MHC class I and OX40L, and sometimes 4–1BBL or ICAM-1, suggesting that MC may present autoantigens to CD8+ T-cells and/or co-stimulatory signals. Abnormal MC numbers, activities, and interactions with CD8+ T-cells were also seen in the grafted C3H/HeJ mouse model of AA and in a new humanized mouse model for AA. These phenomenological in vivo data suggest the novel AA pathobiology concept that perifollicular MCs are skewed towards pro-inflammatory activities that facilitate cross-talk with CD8+ T-cells in this disease, thus contributing to triggering HF-IP collapse in AA. If confirmed, MCs and their CD8+ T-cell interactions could become a promising new therapeutic target in the future management of AA.
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Affiliation(s)
- Marta Bertolini
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Münster, Münster, Germany
| | - Federica Zilio
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Alfredo Rossi
- Department of Internal Medicine and Medical Specialties, University “La Sapienza”, Rome, Italy
| | - Patrick Kleditzsch
- Department of Gynaecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Vladimir E. Emelianov
- Department of Pharmacology, Clinical Pharmacology and Biochemistry, Chuvash State University Medical School, Cheboksary, Russia
| | - Amos Gilhar
- Laboratory for Skin Research, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Flieman Medical Center, Haifa, Israel
| | - Aviad Keren
- Laboratory for Skin Research, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Katja C. Meyer
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Eddy Wang
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kevin McElwee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ralf Paus
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Münster, Münster, Germany
- Institute for Inflammation and Repair, University of Manchester, Manchester, United Kingdom
- * E-mail:
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Hair Follicle Mesenchyme-Associated PD-L1 Regulates T-Cell Activation Induced Apoptosis: A Potential Mechanism of Immune Privilege. J Invest Dermatol 2014; 134:736-745. [DOI: 10.1038/jid.2013.368] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 12/18/2022]
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Bakry OA, Basha MA, El Shafiee MK, Shehata WA. Thyroid disorders associated with alopecia areata in egyptian patients. Indian J Dermatol 2014; 59:49-55. [PMID: 24470660 PMCID: PMC3884928 DOI: 10.4103/0019-5154.123494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Alopecia areata (AA) is a common form of localized, non-scarring hair loss. The etiopathogenesis of the disease is still unclear, but the role of autoimmunity is strongly suggested. AA is commonly associated with various autoimmune disorders; the most frequent among them is autoimmune thyroid disorders. AIM To determine whether AA is associated with thyroid autoimmunity or thyroid function abnormalities in Egyptian patients. MATERIALS AND METHODS Fifty subjects with AA (37 males and 13 females) without clinical evidence of thyroid disorders were selected from Dermatology Outpatient Clinic, Menoufiya University Hospital, Menoufiya Governorate, Egypt, during the period from June 2009 to February 2010. They were divided into 3 groups according to severity of AA. Fifty age and sex-matched healthy volunteers (35 males and 15 females) were selected as a control group. Every case and control were subjected to history taking, complete general and dermatological examination. Venous blood samples were taken from cases and controls after taking their consents for measurement of thyroid stimulating hormone (TSH), free T3, freeT4 and detection of Anti-thyroglobulin Antibody (Tg-Ab) and Anti-thyroid Peroxidase Antibody (TPO-Ab). RESULTS Subclinical hypothyroidism was detected in 16% of cases. There were statistically significant differences between cases and controls regarding levels of TSH, free T3 and free T4. There were significant differences between cases and controls regarding the presence of Tg-Ab and TPO-Ab. CONCLUSIONS Every patient with AA should be screened for thyroid functions and presence of thyroid autoantibodies even in absence of clinical manifestations suggestive of thyroid affection.
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Affiliation(s)
- Ola A Bakry
- Department of Dermatology, Andrology and S.T.Ds, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | - Mohamed A Basha
- Department of Dermatology, Andrology and S.T.Ds, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | - Maather K El Shafiee
- Department of Medical Biochemistry, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | - Wafaa A Shehata
- Department of Dermatology, Andrology and S.T.Ds, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
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Alopecia areata after HLA-identical BMT from an affected, sibling donor. Bone Marrow Transplant 2014; 49:592-4. [DOI: 10.1038/bmt.2013.212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Paus R, Bertolini M. The role of hair follicle immune privilege collapse in alopecia areata: status and perspectives. J Investig Dermatol Symp Proc 2013; 16:S25-7. [PMID: 24326544 DOI: 10.1038/jidsymp.2013.7] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Alopecia areata (AA) may represent a CD8+T cell-mediated, organ-specific autoimmune disease in which as yet elusive autoantigens are recognized, once they become exposed by ectopic major histocompatibility complex class I expression by anagen hair follicles (HFs) that have lost their relative immune privilege (IP). On this basis, AA research is chiefly challenged with identifying the autoreactive CD8+T cells and their cognate autoantigens as well as key inducers of HF-IP collapse and "HF-IP guardians" that prevent and/or can restore IP collapse. However, natural killer group 2D-positive (NKG2D+) cells (incl. NK, NKT, and CD8+T cells) and NKG2D-activating ligands from the MICA (MHC I-related chain A) family may also have a key role in AA pathogenesis, as a massive infiltrate of IFN-γ-secreting NKG2D+ cells alone suffices to induce the AA phenotype. Therefore, we speculate that AA may represent a stereotypic, but distinct HF response pattern to inflammatory insults associated with HF-IP collapse.
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Affiliation(s)
- Ralf Paus
- 1] Department of Dermatology, University of Lübeck, Lübeck, Germany [2] Institute of Inflammation and Repair, University of Manchester, Manchester, UK
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McMichael AJ. Excimer laser: a module of the alopecia areata common protocol. J Investig Dermatol Symp Proc 2013; 16:S77-S79. [PMID: 24326569 DOI: 10.1038/jidsymp.2013.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Alopecia areata (AA) is an autoimmune condition characterized by T cell-mediated attack of the hair follicle. The inciting antigenic stimulus is unknown. A dense perbulbar lymphocytic infiltrate and reproducible immunologic abnormalities are hallmark features of the condition. The cellular infiltrate primarily consists of activated T lymphocytes and antigen-presenting Langerhans cells. The xenon chloride excimer laser emits its total energy at the wavelength of 308 nm and therefore is regarded as a "super-narrowband" UVB light source. Excimer laser treatment is highly effective in psoriasis, another T cell-mediated disorder that shares many immunologic features with AA. The excimer laser is superior in inducing T cell apoptosis in vitro compared with narrowband UVB, with paralleled improved clinical efficacy. The excimer laser has been used successfully in patients with AA. In this context, evaluation of the potential benefit of 308-nm excimer laser therapy in the treatment of AA is clinically warranted. Herein, the use of a common treatment protocol with a specifically designed module to study the outcome of excimer laser treatment on moderate-to-severe scalp AA in adults is described.
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Affiliation(s)
- Amy J McMichael
- Department of Dermatology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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McElwee KJ, Gilhar A, Tobin DJ, Ramot Y, Sundberg JP, Nakamura M, Bertolini M, Inui S, Tokura Y, Jr LEK, Duque-Estrada B, Tosti A, Keren A, Itami S, Shoenfeld Y, Zlotogorski A, Paus R. What causes alopecia areata? Exp Dermatol 2013; 22:609-26. [PMID: 23947678 PMCID: PMC4094373 DOI: 10.1111/exd.12209] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The pathobiology of alopecia areata (AA), one of the most frequent autoimmune diseases and a major unsolved clinical problem, has intrigued dermatologists, hair biologists and immunologists for decades. Simultaneously, both affected patients and the physicians who take care of them are increasingly frustrated that there is still no fully satisfactory treatment. Much of this frustration results from the fact that the pathobiology of AA remains unclear, and no single AA pathogenesis concept can claim to be universally accepted. In fact, some investigators still harbour doubts whether this even is an autoimmune disease, and the relative importance of CD8(+) T cells, CD4(+) T cells and NKGD2(+) NK or NKT cells and the exact role of genetic factors in AA pathogenesis remain bones of contention. Also, is AA one disease, a spectrum of distinct disease entities or only a response pattern of normal hair follicles to immunologically mediated damage? During the past decade, substantial progress has been made in basic AA-related research, in the development of new models for translationally relevant AA research and in the identification of new therapeutic agents and targets for future AA management. This calls for a re-evaluation and public debate of currently prevalent AA pathobiology concepts. The present Controversies feature takes on this challenge, hoping to attract more skin biologists, immunologists and professional autoimmunity experts to this biologically fascinating and clinically important model disease.
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Affiliation(s)
- K. J. McElwee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - A. Gilhar
- Laboratory for Skin, Research, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel Marta Bertolini
| | - D. J. Tobin
- Centre for Skin Sciences, School of Life Sciences, University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
| | - Y. Ramot
- Department of Dermatology, Hadassah- Hebrew University Medical Center, Jerusalem 91120, Israel
| | - J. P. Sundberg
- The Jackson Laboratory, Bar Harbor, ME, USA; Division of Dermatology, Skin Disease Research Center, Vanderbilt University, Nashville, TN, USA
| | - M. Nakamura
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan Yoshiki Tokura
| | - M. Bertolini
- Department of Dermatology, University of Lübeck, Germany Yehuda Shoenfeld
| | - S. Inui
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Y. Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - L. E. King Jr
- The Jackson Laboratory, Bar Harbor, ME, USA; Division of Dermatology, Skin Disease Research Center, Vanderbilt University, Nashville, TN, USA
| | - B. Duque-Estrada
- Instituto de Dermatologia Prof. Rubem David Azulay, Rio de Janeiro, Brazil Antonella Tosti
| | - A Tosti
- Department of Dermatology, University of Miami, Miami, FL, USA
| | - A. Keren
- Laboratory for Skin, Research, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel Marta Bertolini
| | - S. Itami
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Y. Shoenfeld
- Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - A. Zlotogorski
- Department of Dermatology, Hadassah- Hebrew University Medical Center, Jerusalem 91120, Israel
| | - R. Paus
- Department of Dermatology, University of Lübeck, Germany; Institute of Inflammation and Repair, University of Manchester, Manchester, UK ,
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Tojo G, Fujimura T, Kawano M, Ogasawara K, Kambayashi Y, Furudate S, Mizuashi M, Aiba S. Comparison of interleukin-17- producing cells in different clinical types of alopecia areata. Dermatology 2013; 227:78-82. [PMID: 24008930 DOI: 10.1159/000353159] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/15/2013] [Indexed: 11/19/2022] Open
Abstract
T helper 17 cells, characterized by interleukin-17 (IL-17) production, play a critical role in the pathogenesis of autoimmune disease, including alopecia areata (AA). In this report, we employed immunohistochemical staining for IL-17-producing cells, as well as interferon-γ-producing cells, granulysin-bearing cells and Foxp3+ regulatory T cells, and performed a quantitative analysis of IL-17-producing cells in the lesional skin of several clinical forms of AA by TissueFAXS analysis. Among them, interestingly, the ratio of IL-17-producing cells in acute, diffuse and total alopecia was significantly lower than those of multiple types of AA. Our study sheds light on one of the possible immunological mechanisms of AA.
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Affiliation(s)
- Genichi Tojo
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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70
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Erb U, Freyschmidt-Paul P, Zöller M. Tolerance induction by hair-specific keratins in murine alopecia areata. J Leukoc Biol 2013; 94:845-57. [PMID: 23817565 DOI: 10.1189/jlb.0413196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AA is a presumptive autoimmune disease, severely damaging the hair follicle. Hair- and nail-specific keratins are discussed as potential candidates, which we controlled in C3H/HeJ mice that develop AA spontaneously or after skin transplantation. From nine keratins, K71 and K31 peptides supported T cell activation when presented by DCs to syngeneic naive T cells, and young C3H/HeJ mice receiving s.c. injections of peptide-loaded DC developed AA. The frequency of K71- and K31-specific CD4(+) and CD8(+) T cells increased four- to fivefold by vaccination, which corresponds with the frequency seen in skin transplantation-induced AA mice. Also, accessory molecule expression, the cytokine profile with a dominance of IFN-γ-expressing T cells, the proliferative response against AA lysate or peptide-loaded DCs, as well as peptide-specific cytotoxic T cells were similar in keratin peptide- and skin transplantation-induced AA. Instead, vaccination with soluble K71 or K31 peptides significantly retarded AA induction and prevented progression. Soluble peptide vaccination did not provoke immunosuppression but induced long-lasting T cell anergy with unresponsiveness to DC-presented K71 and K31 peptides. Thus, keratins K71 and K31 contribute to AA induction, and peptide application in a nonimmunogenic form serves as an efficient therapeutic.
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Affiliation(s)
- Ulrike Erb
- 1.University Hospital of Surgery, Im Neuenheimer Feld 365, D 69120 Heidelberg, Germany.
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71
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Avci P, Sadasivam M, Gupta A, De Melo WC, Huang YY, Yin R, Chandran R, Kumar R, Otufowora A, Nyame T, Hamblin MR. Animal models of skin disease for drug discovery. Expert Opin Drug Discov 2013; 8:331-55. [PMID: 23293893 DOI: 10.1517/17460441.2013.761202] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Discovery of novel drugs, treatments, and testing of consumer products in the field of dermatology is a multi-billion dollar business. Due to the distressing nature of many dermatological diseases, and the enormous consumer demand for products to reverse the effects of skin photodamage, aging, and hair loss, this is a very active field. AREAS COVERED In this paper, we will cover the use of animal models that have been reported to recapitulate to a greater or lesser extent the features of human dermatological disease. There has been a remarkable increase in the number and variety of transgenic mouse models in recent years, and the basic strategy for constructing them is outlined. EXPERT OPINION Inflammatory and autoimmune skin diseases are all represented by a range of mouse models both transgenic and normal. Skin cancer is mainly studied in mice and fish. Wound healing is studied in a wider range of animal species, and skin infections such as acne and leprosy also have been studied in animal models. Moving to the more consumer-oriented area of dermatology, there are models for studying the harmful effect of sunlight on the skin, and testing of sunscreens, and several different animal models of hair loss or alopecia.
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Affiliation(s)
- Pinar Avci
- Harvard Medical School, Massachusetts General Hospital, Wellman Center for Photomedicine, Department of Dermatology, Boston MA, USA
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Friedland R, Tal R, Lapidoth M, Zvulunov A, Ben Amitai D. Pulse Corticosteroid Therapy for Alopecia Areata in Children: A Retrospective Study. Dermatology 2013; 227:37-44. [DOI: 10.1159/000351559] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/19/2013] [Indexed: 11/19/2022] Open
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Yazdan P. Update on the Genetics of Androgenetic Alopecia, Female Pattern Hair Loss, and Alopecia Areata: Implications for Molecular Diagnostic Testing. ACTA ACUST UNITED AC 2012; 31:258-66. [DOI: 10.1016/j.sder.2012.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/14/2012] [Indexed: 11/30/2022]
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74
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Multivariate analysis of prognostic factors in patients with rapidly progressive alopecia areata. J Am Acad Dermatol 2012; 67:1163-73. [DOI: 10.1016/j.jaad.2012.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 05/14/2012] [Accepted: 06/05/2012] [Indexed: 12/14/2022]
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Autoimmune disease induction in a healthy human organ: a humanized mouse model of alopecia areata. J Invest Dermatol 2012; 133:844-847. [PMID: 23096715 DOI: 10.1038/jid.2012.365] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Messenger AG, McKillop J, Farrant P, McDonagh AJ, Sladden M. British Association of Dermatologists' guidelines for the management of alopecia areata 2012. Br J Dermatol 2012; 166:916-26. [PMID: 22524397 DOI: 10.1111/j.1365-2133.2012.10955.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A G Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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Affiliation(s)
- Amos Gilhar
- Flieman Hospital, and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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78
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Kinori M, Bertolini M, Funk W, Samuelov L, Meyer KC, Emelianov VU, Hasse S, Paus R. Calcitonin gene-related peptide (CGRP) may award relative protection from interferon-γ-induced collapse of human hair follicle immune privilege. Exp Dermatol 2012; 21:223-6. [DOI: 10.1111/j.1600-0625.2011.01432.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Effects of the Lexington LaserComb on hair regrowth in the C3H/HeJ mouse model of alopecia areata. Lasers Med Sci 2011; 27:431-6. [PMID: 21739260 DOI: 10.1007/s10103-011-0953-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/20/2011] [Indexed: 02/08/2023]
Abstract
Alopecia areata (AA) is a common autoimmune disease that presents with non-scarring alopecia. It is characterized by intra- or peri-follicular lymphocytic infiltrates composed of CD4+ and CD8+ T-cells on histology. To this day, few treatments are effective for AA. Here we present findings of using a low-level laser comb to alleviate the symptoms of AA in a C3H/HeJ mouse model for AA. Fourteen C3H/HeJ mice with induced AA were used in this study. Two were killed to confirm AA through histology. The remaining 12 mice were randomized into two groups; group I received HairMax LaserComb (wavelength: 655 nm, beam diameter <5 mm; divergence 57 mrad; nine lasers) for 20 s daily, three times per week for a total of 6 weeks; group II was treated similarly, except that the laser was turned off (sham-treated). After 6 weeks of LaserComb treatment, hair regrowth was observed in all the mice in group I (laser-treated) but none in group II (sham-treated). On histology, increased number of anagen hair follicles was observed in laser-treated mice. On the other hand, sham-treated mice demonstrated hair follicles in the telogen phase with no hair shaft. LaserComb seems to be an effective and convenient device for the treatment of AA in the C3H/HeJ mouse model. Human studies are required to determine the efficacy and safety of this device for AA therapy.
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Abstract
The role of neurohormones and neuropeptides in human hair follicle (HF) pigmentation extends far beyond the control of melanin synthesis by α-MSH and ACTH and includes melanoblast differentiation, reactive oxygen species scavenging, maintenance of HF immune privilege, and remodeling of the HF pigmentary unit (HFPU). It is now clear that human HFs are not only a target of multiple neuromediators, but also are a major non-classical production site for neurohormones such as CRH, proopiomelanocortin, ACTH, α-MSH, ß-endorphin, TRH, and melatonin. Moreover, human HFs have established a functional peripheral equivalent of the hypothalamic-pituitary-adrenal axis. By charting the author's own meanderings through the jungle of hair pigmentation research, the current perspectives essay utilizes four clinical observations - hair repigmentation, canities, poliosis, and 'overnight greying'- as points of entry into the enigmas and challenges of .pigmentary HF neuroendocrinology. After synthesizing key principles and defining major open questions in the field, selected research avenues are delineated that appear clinically most promising. In this context, novel neuroendocrinological strategies to retard or reverse greying and to reduce damage to the HFPU are discussed.
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Affiliation(s)
- Ralf Paus
- Department of Dermatology, University of Lübeck, Lübeck, Germany.
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82
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Kaufman G, d'Ovidio R, Kaldawy A, Assy B, Ullmann Y, Etzioni A, Paus R, Gilhar A. An unexpected twist in alopecia areata pathogenesis: are NK cells protective and CD49b+ T cells pathogenic? Exp Dermatol 2011; 19:e347-9. [PMID: 20653774 DOI: 10.1111/j.1600-0625.2010.01106.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Natural killer (NK) cells have become a recent focus of interest in alopecia areata (AA) research. To further investigate their role in an established mouse model of AA, lesional skin from older C3H/HeJ mice with AA was grafted to young C3H/HeJ female mice, and NK cells were depleted by continuous administration of rabbit anti-asialo GM1. As expected, this significantly reduced the number of pure NK cells in murine skin, as assessed by NKp46 quantitative immunohistochemistry. Quite unexpectedly, however, the onset of hair loss in C3H/HeJ mice was accelerated, rather than retarded. NK cell depletion was accompanied by a significant increase in the number of perifollicular CD49b+T cells in the alopecic skin of anti-asialo GM1-treated mice. These findings underscore the need to carefully distinguish in future AA research between pure NK cells and defined subsets of CD49b+ lymphocytes, as they may exert diametrically opposed functions in hair follicle immunology and immunopathology.
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Gilhar A. Collapse of Immune Privilege in Alopecia Areata: Coincidental or Substantial? J Invest Dermatol 2010; 130:2535-7. [DOI: 10.1038/jid.2010.260] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Yoo KH, Lee JW, Li K, Kim BJ, Kim MN. Photodynamic Therapy with Methyl 5-Aminolevulinate Acid Might Be Ineffective in Recalcitrant Alopecia Totalis Regardless of Using a Microneedle Roller to Increase Skin Penetration. Dermatol Surg 2010; 36:618-22. [DOI: 10.1111/j.1524-4725.2010.01515.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gregoriou S, Papafragkaki D, Kontochristopoulos G, Rallis E, Kalogeromitros D, Rigopoulos D. Cytokines and other mediators in alopecia areata. Mediators Inflamm 2010; 2010:928030. [PMID: 20300578 PMCID: PMC2837895 DOI: 10.1155/2010/928030] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 01/28/2010] [Accepted: 01/28/2010] [Indexed: 11/17/2022] Open
Abstract
Alopecia areata, a disease of the hair follicles with multifactorial etiology and a strong component of autoimmune origin, has been extensively studied as far as the role of several cytokines is concerned. So far, IFN-gamma, interleukins, TNF-alpha, are cytokines that are well known to play a major role in the pathogenesis of the disease, while several studies have shown that many more pathways exist. Among them, MIG, IP-10, BAFF, HLA antigens, MIG, as well as stress hormones are implicated in disease onset and activity. Within the scope of this paper, the authors attempt to shed light upon the complexity of alopecia areata underlying mechanisms and indicate pathways that may suggest future treatments.
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Affiliation(s)
- Stamatis Gregoriou
- Andreas Sygros Hospital, University of Athens Medical School, 5 Ionos Dragoumi Street, 16121 Athens, Greece.
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Waldman A, Segal R, Berdicevsky I, Gilhar A. CD4+ and CD8+ T cells mediated direct cytotoxic effect against Trichophyton rubrum and Trichophyton mentagrophytes. Int J Dermatol 2009; 49:149-57. [PMID: 19968718 DOI: 10.1111/j.1365-4632.2009.04222.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cellular immune system is the most dominant factor in curing acute dermatophytosis. However, the exact immune mechanisms involved in generating this defense are complex and still obscure. The aim of this study was to investigate the fungicidal mechanism of T cells in the normal population versus patients with chronic fungal infections. METHODS Thirty patients were included in the study: 15 patients with chronic dermatophytosis and 15 normal healthy patients with a history of acute dermatophytosis. The procedures were performed as follows. 1) Proliferation and cytotoxic activity of lymphocytes cultured with various dermatophytes homogenate such as, Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum gypseum. 2) CD4(+) and CD8(+) T cells were separated by magnetic beads before culture with fresh spores of either T. mentagrophytes or T. rubrum. 3) Routine histology and ultrastructural study were performed to illustrate the mode of activity of the T cells against the dermatophytes. RESULTS The study showed that both CD4 and CD8 possess cytotoxic activity against dermatophytes. However, the results demonstrated a suppression of lymphocyte proliferation response and a significant lower cytotoxic effect in chronic patients. Ultra structure and histological evaluation of the culture of hyphae with CD4(+) or CD8(+) T cells showed more prominently destructive effects in the culture of cells that had been obtained from normal population than those of patients with long-lasting fungal infections. CONCLUSION The study suggests a selective impairment of lymphocyte function against dermatophytes, in patients with chronic dermatophytoses.
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Affiliation(s)
- Arie Waldman
- Department of Microbiology, B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Lee JW, Yoo KH, Kim BJ, Kim MN. Photodynamic therapy with methyl 5-aminolevulinate acid combined with microneedle treatment in patients with extensive alopecia areata. Clin Exp Dermatol 2009; 35:548-9. [DOI: 10.1111/j.1365-2230.2009.03695.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Efentaki P, Altenburg A, Haerting J, Zouboulis CC. Medium-dose prednisolone pulse therapy in alopecia areata. DERMATO-ENDOCRINOLOGY 2009; 1:310-3. [PMID: 21572877 PMCID: PMC3092572 DOI: 10.4161/derm.1.6.11236] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 01/19/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the exact etiology of alopecia areata is still unknown, systemic prednisolone treatment seem to be effective in early stages but significant side effects may occur leading to discontinuation of treatment. OBJECTIVE Evaluation of efficacy and saftety of a short-term medium-dose pulse prednisolone treatment in alopecia areata. RESULTS 84% of the patients with multifocal alopecia areata markedly improved after the completion of the three courses. A patient with the ophiasis type only responded after the third course, but relapsed 7 months later. The patients with alopecia areata totalis and universalis did not respond to the treatment. No major side effects were observed. METHODS Monocenter prospective study of intravenous 100 mg intravenous prednisolone pulse therapy on 3 consecutive days at 1-month-intervals for three courses in 23 patients with active alopecia areata rapidly evolving and/or resistant to topical therapies and no contraindication for systemic steroids. CONCLUSION A series of three monthly courses of medium-dose prednisolone pulse therapy is effective and well tolerated in most patients with active, multifocal alopecia areata. The results are rather disappointing in patients with alopecia areara totalis/universalis.
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Affiliation(s)
- Pinelopi Efentaki
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
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Trautman S, Thompson M, Roberts J, Thompson CT. Melanocytes: a possible autoimmune target in alopecia areata. J Am Acad Dermatol 2009; 61:529-30. [PMID: 19700020 DOI: 10.1016/j.jaad.2009.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 01/12/2009] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
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90
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Barahmani N, Schabath MB, Duvic M. History of atopy or autoimmunity increases risk of alopecia areata. J Am Acad Dermatol 2009; 61:581-91. [PMID: 19608295 DOI: 10.1016/j.jaad.2009.04.031] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 04/01/2009] [Accepted: 04/03/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND The association between a history of atopy or autoimmune diseases and risk of alopecia areata (AA) is not well established. OBJECTIVE The purpose of this study was to use the National AA Registry database to further investigate the association between history of atopy or autoimmune diseases and risk of AA. METHODS A total of 2613 self-registered sporadic cases (n = 2055) and controls (n = 558) were included in this analysis. RESULTS Possessing a history of any atopic (odds ratio = 2.00; 95% confidence interval 1.50-2.54) or autoimmune (odds ratio = 1.73; 95% confidence interval 1.10-2.72) disease was associated with an increased risk of AA. There was no trend for possessing a history of more than one atopic or autoimmune disease and increasing risk of AA. LIMITATIONS Recall, reporting, and recruiting bias are potential sources of limitations in this analysis. CONCLUSION This analysis revealed that a history of atopy and autoimmune disease was associated with an increased risk of AA and that the results were consistent for both the severe subtype of AA (ie, alopecia totalis and alopecia universalis) and the localized subtype (ie, AA persistent).
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Affiliation(s)
- Nazila Barahmani
- Department of Dermatology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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91
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Abstract
Alopecia areata is a common condition causing nonscarring hair loss. It may be patchy, involve the entire scalp (alopecia totalis) or whole body (alopecia universalis). Patients may recover spontaneously but the disorder can follow a course of recurrent relapses or result in persistent hair loss. Alopecia areata can cause great psychological distress, and the most important aspect of management is counseling the patient about the unpredictable nature and course of the condition as well as the available effective treatments, with details of their side effects. Although many treatments have been shown to stimulate hair growth in alopecia areata, there are limited data on their long-term efficacy and impact on quality of life. We review the evidence for the following commonly used treatments: corticosteroids (topical, intralesional, and systemic), topical sensitizers (diphenylcyclopropenone), psoralen and ultraviolet A phototherapy (PUVA), minoxidil and dithranol.
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Affiliation(s)
- Seema Garg
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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92
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INUI S, NAKAJIMA T, TODA N, ITAMI S. Fexofenadine hydrochloride enhances the efficacy of contact immunotherapy for extensive alopecia areata: Retrospective analysis of 121 cases. J Dermatol 2009; 36:323-7. [DOI: 10.1111/j.1346-8138.2009.00647.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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93
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94
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Sun J, Silva KA, McElwee KJ, King LE, Sundberg JP. The C3H/HeJ mouse and DEBR rat models for alopecia areata: review of preclinical drug screening approaches and results. Exp Dermatol 2009; 17:793-805. [PMID: 18798913 DOI: 10.1111/j.1600-0625.2008.00773.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The C3H/HeJ inbred mouse strain and the Dundee Experimental Bald Rat (DEBR) strain spontaneously develop adult onset alopecia areata (AA), a cell-mediated disease directed against actively growing hair follicles. The low frequency of AA and the inability to predict the stage of AA as it evolves in the naturally occuring C3H/HeJ model of AA can be converted into a highly predictable system by grafting full thickness skin from AA-affected mice to normal haired mice of the same strain. The rat DEBR model develops spontaneous AA at a higher frequency than in the mouse model but they are more expensive to use in drug studies owing to their larger size. Regardless of the shortcomings of either model, these rodent models can be used succesfully to screen novel or approved drugs for efficacy to treat human AA. As the pathogenesis of AA follows the canonical lymphocytic co-stimulatory cascade in the mouse AA model, it can be used to screen compounds potentially useful to treat a variety of cell-mediated diseases. Efficacy of various agents can easily be screened by simply observing the presence, rate, and cosmetic acceptability of hair regrowth. More sophisticated assays can refine how the drugs induce hair regrowth and evaluate the underlying pathogenesis of AA. Some drugs commonly used to treat human AA patients work equally as well in both rodent models validating their usefulness as models for drug efficacy and safety for humanAA.
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Affiliation(s)
- Jing Sun
- The Jackson Laboratory, Bar Harbor, ME 04609-1500, USA
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95
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96
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Yoshino T, Asada H, Ando Y, Fujii H, Yamaguchi Y, Yoshikawa K, Itami S. Impaired responses of peripheral blood mononuclear cells to T-cell stimulants in alopecia areata patients with a poor response to topical immunotherapy. Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.2001.04398.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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97
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Nakamura M, Jo JI, Tabata Y, Ishikawa O. Controlled delivery of T-box21 small interfering RNA ameliorates autoimmune alopecia (Alopecia Areata) in a C3H/HeJ mouse model. THE AMERICAN JOURNAL OF PATHOLOGY 2008; 172:650-8. [PMID: 18245811 DOI: 10.2353/ajpath.2008.061249] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Autoimmune alopecia (alopecia areata) is considered to be triggered by a collapse of immune privilege in hair follicles. Here we confirmed that infiltrating CD4 T lymphocytes around hair follicles of patients with alopecia areata were primarily CCR5-positive with few CCR4-positive cells, suggesting a dominant role of Th1 cells in the alopecic lesion. Given this finding, we sought to elucidate the effect of cytokine therapy in C3H/HeJ mice, a mouse model of alopecia areata, by applying recombinant interleukin-4 and neutralizing anti-interferon-gamma antibody. We found that local injections of both interleukin-4 and neutralizing anti-interferon-gamma antibody effectively treated alopecia in C3H/HeJ mice. Results from immunohistochemistry and semiquantitative reverse transcription-polymerase chain reaction demonstrated that intralesional injection of interleukin-4 suppressed CD8 T cell infiltrates around the hair follicles and repressed enhanced interferon-gamma mRNA expression in the affected alopecic skin. Furthermore, Th1 transcription factor T-box21 small interfering RNAs conjugated to cationized gelatin showed mitigating effects on alopecia in C3H/HeJ mice, resulting in the restoration of hair shaft elongation. Taken together, the use of gelatin-small interfering RNA conjugates promises to be a novel, efficient, and safe tool as an alternative gene therapy for the treatment of various human diseases. To our knowledge, this is the first report of effective controlled delivery of small interfering RNA using biodegradable cationized gelatin microspheres in an animal model of disease.
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98
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Gilhar A, Paus R, Kalish RS. Lymphocytes, neuropeptides, and genes involved in alopecia areata. J Clin Invest 2007; 117:2019-27. [PMID: 17671634 PMCID: PMC1934574 DOI: 10.1172/jci31942] [Citation(s) in RCA: 211] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Many lessons in autoimmunity - particularly relating to the role of immune privilege and the interplay between genetics and neuroimmunology - can be learned from the study of alopecia areata, the most common cause of inflammation-induced hair loss. Alopecia areata is now understood to represent an organ-restricted, T cell-mediated autoimmune disease of hair follicles. Disease induction is associated with collapse of hair follicle immune privilege in both humans and in animal models. Here, the role of HLA associations, other immunogenetic factors, and neuroendocrine parameters in alopecia areata pathogenesis are reviewed. This instructive and clinically significant model disease deserves more widespread interest in the immunology community.
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Affiliation(s)
- Amos Gilhar
- Skin Research Laboratory, The Ruth and Bruce Rappaport Faculty of Medicine, Technion — Israel Institute of Technology and Flieman Medical Center, Haifa, Israel.
University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany.
Department of Dermatology, School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Ralf Paus
- Skin Research Laboratory, The Ruth and Bruce Rappaport Faculty of Medicine, Technion — Israel Institute of Technology and Flieman Medical Center, Haifa, Israel.
University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany.
Department of Dermatology, School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Richard S. Kalish
- Skin Research Laboratory, The Ruth and Bruce Rappaport Faculty of Medicine, Technion — Israel Institute of Technology and Flieman Medical Center, Haifa, Israel.
University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany.
Department of Dermatology, School of Medicine, Stony Brook University, Stony Brook, New York, USA
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99
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Siebenhaar F, Sharov AA, Peters EMJ, Sharova TY, Syska W, Mardaryev AN, Freyschmidt-Paul P, Sundberg JP, Maurer M, Botchkarev VA. Substance P as an Immunomodulatory Neuropeptide in a Mouse Model for Autoimmune Hair Loss (Alopecia Areata). J Invest Dermatol 2007; 127:1489-97. [PMID: 17273166 DOI: 10.1038/sj.jid.5700704] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alopecia areata (AA) is an autoimmune disorder of the hair follicle characterized by inflammatory cell infiltrates around actively growing (anagen) hair follicles. Substance P (SP) plays a critical role in the cutaneous neuroimmune network and influences immune cell functions through the neurokinin-1 receptor (NK-1R). To better understand the role of SP as an immunomodulatory neuropeptide in AA, we studied its expression and effects on immune cells in a C3H/HeJ mouse model for AA. During early stages of AA development, the number of SP-immunoreactive nerve fibers in skin is increased, compared to non-affected mice. However, during advanced stages of AA, the number of SP-immunoreactive nerves and SP protein levels in skin are decreased, whereas the expression of the SP-degrading enzyme neutral endopeptidase (NEP) is increased, compared to control skin. In AA, NK-1R is expressed on CD8+ lymphocytes and macrophages accumulating around affected hair follicles. Additional SP supply to the skin of AA-affected mice leads to a significant increase of mast cell degranulation and to accelerated hair follicle regression (catagen), accompanied by an increase of CD8+ cells-expressing granzyme B. These data suggest that SP, NEP, and NK-1R serve as important regulators in the molecular signaling network modulating inflammatory response in autoimmune hair loss.
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Affiliation(s)
- Frank Siebenhaar
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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100
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Kalish RS. Clues from Alopecia Areata on the Role of Neuropeptides in the Initiation of Autoimmunity. J Invest Dermatol 2007; 127:1289-91. [PMID: 17502860 DOI: 10.1038/sj.jid.5700655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A fascinating question regarding the pathogenesis of alopecia areata is the potential linkage with the brain. Siebenharr et al. demonstrate that substance P fibers are increased in early lesions, and that substance P treatment induces catagen follicles along with activated CD8+ T cells. Potentially, neuropeptides serve as the initial insult resulting in loss of tolerance and autoimmune disease.
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Affiliation(s)
- Richard S Kalish
- Department of Dermatology, State University of New York at Stony Brook, Stony Brook, New York 11794-8165, USA.
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