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Fukuyama M, Ito T, Ohyama M. Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines. J Dermatol 2021; 49:19-36. [PMID: 34709679 DOI: 10.1111/1346-8138.16207] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2- and Th17-associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first-line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced-based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.
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Affiliation(s)
- Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
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2
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Suzuki T, Ito T, Gilhar A, Tokura Y, Reich K, Paus R. The hair follicle-psoriasis axis: Shared regulatory mechanisms and therapeutic targets. Exp Dermatol 2021; 31:266-279. [PMID: 34587317 DOI: 10.1111/exd.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 12/17/2022]
Abstract
It has long been known that there is a special affinity of psoriasis for the scalp: Here, it occurs most frequently, lesions terminate sharply in frontal skin beyond the hair line and are difficult to treat. Yet, surprisingly, scalp psoriasis only rarely causes alopecia, even though the pilosebaceous unit clearly is affected. Here, we systematically explore the peculiar, insufficiently investigated connection between psoriasis and growing (anagen) terminal scalp hair follicles (HFs), with emphasis on shared regulatory mechanism and therapeutic targets. Interestingly, several drugs and stressors that can trigger/aggravate psoriasis can inhibit hair growth (e.g. beta-blockers, chloroquine, carbamazepine, interferon-alpha, perceived stress). Instead, several anti-psoriatic agents can stimulate hair growth (e.g. cyclosporine, glucocorticoids, dithranol, UV irradiation), while skin/HF trauma (Köbner phenomenon/depilation) favours the development of psoriatic lesions and induces anagen in "quiescent" (telogen) HFs. On this basis, we propose two interconnected working models: (a) the existence of a bidirectional "hair follicle-psoriasis axis," along which keratinocytes of anagen scalp HFs secrete signals that favour the development and maintenance of psoriatic scalp lesions and respond to signals from these lesions, and (b) that anagen induction and psoriatic lesions share molecular "switch-on" mechanisms, which invite pharmacological targeting, once identified. Therefore, we advocate a novel, cross-fertilizing and integrative approach to psoriasis and hair research that systematically characterizes the "HF-psoriasis axis," focused on identification and therapeutic targeting of selected, shared signalling pathways in the future management of both, psoriasis and hair growth disorders.
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Affiliation(s)
- Takahiro Suzuki
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan
| | - Kristian Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Monasterium Laboratory, Münster, Germany
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Monasterium Laboratory, Münster, Germany.,Centre for Dermatology Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Center, Manchester, UK
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3
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Dai Z, Wang EHC, Petukhova L, Chang Y, Lee EY, Christiano AM. Blockade of IL-7 signaling suppresses inflammatory responses and reverses alopecia areata in C3H/HeJ mice. SCIENCE ADVANCES 2021; 7:eabd1866. [PMID: 33811067 PMCID: PMC11060042 DOI: 10.1126/sciadv.abd1866] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
The interleukin-7 (IL-7) signaling pathway plays an important role in regulation of T cell function and survival. We detected overexpression of IL-7 in lesional skin from both humans and C3H/HeJ mice with alopecia areata (AA), a T cell-mediated autoimmune disease of the hair follicle. We found that exogenous IL-7 accelerated the onset of AA by augmenting the expansion of alopecic T cells. Conversely, blockade of IL-7 stopped the progression of AA and reversed early AA in C3H/HeJ mice. Mechanistically, we observed that IL-7Rα blockade substantially reduced the total number of most T cell subsets, but relative sparing of regulatory T cells (Tregs). We postulated that short-term anti-IL-7Rα treatment in combination with a low dose of Treg-tropic cytokines might improve therapeutic efficacy in AA. We demonstrated that short-term IL-7Rα blockade in combination with low doses of Treg-tropic cytokines enhanced therapeutic effects in the treatment of AA, and invite further clinical investigation.
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Affiliation(s)
- Zhenpeng Dai
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Eddy Hsi Chun Wang
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Lynn Petukhova
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Yuqian Chang
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Eunice Yoojin Lee
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Angela M Christiano
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
- Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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4
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Afford R, Leung AKC, Lam JM. Pediatric Alopecia Areata. Curr Pediatr Rev 2021; 17:45-54. [PMID: 32351186 DOI: 10.2174/1573396316666200430084825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology. OBJECTIVE To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric alopecia areata. METHODS The search term "Alopecia areata" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. RESULTS AA is an autoimmune disease of unknown etiology. It is the third most common dermatologic presentation in children with a lifetime risk of 1-2%. Diagnosing AA can be made on the basis of the history and clinical findings. Patients will often present with patchy, non-scarring hair loss, generally affecting the scalp. History may reveal a personal or family medical history of autoimmune or atopic disease or a recent stressful event. Tricoscopic examination will classically show "exclamation point hairs" and "yellow dots". Nonspecific nail changes may be present. Other clinical variants include alopecia totalis, alopecia universalis, ophiasis, sisaipho, and Canitis subita. There are multiple treatment options for AA, including conservative treatment, and topical, oral, and injectable medications. CONCLUSION AA is an autoimmune disease with a heterogeneous presentation and unpredictable clinical course. Although there is no cure for AA, there are many current treatment options available to help manage this disfiguring disease.
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Affiliation(s)
- Rebecca Afford
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Gilhar A, Laufer Britva R, Keren A, Paus R. Mouse Models of Alopecia Areata: C3H/HeJ Mice Versus the Humanized AA Mouse Model. J Investig Dermatol Symp Proc 2020; 20:S11-S15. [PMID: 33099377 DOI: 10.1016/j.jisp.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The C3H/HeJ model has long dominated basic alopecia areata (AA) in vivo research and has been used as proof-of-principle that Jak inhibitors are suitable agents for AA management in vivo. However, its histologic features are not typical of human AA, and it is questionable whether it is sufficiently clinically predictive for evaluating the therapeutic effects of candidate AA agents. Instead, the humanized mouse model of AA has been used to functionally demonstrate the role of key immune cells in AA pathogenesis and to discover human-specific pharmacologic targets in AA management. Therefore, we advocate the use of both models in future preclinical AA research.
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Affiliation(s)
- Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Rimma Laufer Britva
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Aviad Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ralf Paus
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Centre for Dermatology Research, University of Manchester, and NIHR Biomedical Research Centre, Manchester, United Kingdom; Monasterium Laboratory Skin & Hair Research Solutions GmbH, Muenster, Germany
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6
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Ito T, Kageyama R, Nakazawa S, Honda T. Understanding the significance of cytokines and chemokines in the pathogenesis of alopecia areata. Exp Dermatol 2020; 29:726-732. [DOI: 10.1111/exd.14129] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Taisuke Ito
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Reiko Kageyama
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Shinsuke Nakazawa
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Tetsuya Honda
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
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7
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Gilhar A, Laufer-Britva R, Keren A, Paus R. Frontiers in alopecia areata pathobiology research. J Allergy Clin Immunol 2019; 144:1478-1489. [PMID: 31606262 DOI: 10.1016/j.jaci.2019.08.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
This current review explores selected and as yet insufficiently investigated frontiers in current alopecia areata (AA) pathobiology research, with an emphasis on potential "new" players in AA pathobiology that deserve more systematic exploration and therapeutic targeting. Indeed, new evidence suggests that CD8+ T cells, which have long been thought to be the central players in AA pathobiology, are not the only drivers of disease. Instead, subsets of natural killer (NK) and so-called "unconventional" T cells (invariant NK T cells, γδ T cells, classic NK cells, and type 1 innate lymphoid cells), all of which can produce large amounts of IFN-γ, might also drive AA pathobiology independent of classical, autoantigen-dependent CD8+ T-cell functions. Another important new frontier is the role of regulatory lymphocyte subsets, such as regulatory T cells, γδ regulatory T cells, NKT10 cells, and perifollicular mast cells, in maintaining physiologic hair follicle immune privilege (IP); the extent to which these functions are defective in patients with AA; and how this IP-protective role could be restored therapeutically in patients with established AA. Broadening our AA research horizon along the lines suggested above promises not only to open the door to innovative and even more effective immunotherapy strategies for AA but will also likely be relevant for other autoimmune disorders in which pathobiology, ectopic MHC class I expression, and IP collapse play an important role.
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Affiliation(s)
- Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | | - Aviad Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ralf Paus
- Dr Philipp Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Fla; Dermatology Research Centre, University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
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8
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Lee YR, Lew BL, Sim WY, Lee J, Hong J, Chung BC. Altered polyamine profiling in the hair of patients with androgenic alopecia and alopecia areata. J Dermatol 2019; 46:985-992. [PMID: 31464015 DOI: 10.1111/1346-8138.15063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Abstract
Hair follicles are among the most highly proliferative tissues. Polyamines are associated with proliferation, and several polyamines including spermidine and spermine play anti-inflammatory roles. Androgenic alopecia results from increased dihydrotestosterone metabolism, and alopecia areata is an autoimmune disease. This study aimed to investigate differences in polyamine profiles in hair samples between patients with androgenic alopecia and alopecia areata. Polyamine concentrations were determined through high-performance liquid chromatography-mass spectrometry. Hair samples were derivatized with isobutyl chloroformate. Differences in polyamine levels were observed between androgenic alopecia and alopecia areata compared with normal controls. In particular, polyamine levels were higher in alopecia areata patients than in normal controls. Certain polyamines displayed different concentrations between the androgenic alopecia and alopecia areata groups, suggesting that some polyamines, particularly N-acetyl putrescine (P = 0.007) and N-acetyl cadaverine (P = 0.0021), are significantly different in androgenic alopecia. Furthermore, spermidine (P = 0.021) was significantly different in alopecia areata. Our findings suggest that non-invasive quantification of hair polyamines may help distinguish between androgenic alopecia and alopecia areata. Our study provides novel insights into physiological alterations in patients with androgenic alopecia and those with alopecia areata and reveals some differences in polyamine levels in hair loss diseases with two different modes of action.
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Affiliation(s)
- Yu Ra Lee
- Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul, Korea.,KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, Korea
| | - Bark Lynn Lew
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Woo Young Sim
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Jeongae Lee
- Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul, Korea
| | - Jongki Hong
- KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, Korea.,College of Pharmacy, Kyung Hee University, Seoul, Korea
| | - Bong Chul Chung
- Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul, Korea.,KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, Korea
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9
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Oliveira IS, Ferreira IG, Alexandre-Silva GM, Cerni FA, Cremonez CM, Arantes EC, Zottich U, Pucca MB. Scorpion toxins targeting Kv1.3 channels: insights into immunosuppression. J Venom Anim Toxins Incl Trop Dis 2019; 25:e148118. [PMID: 31131004 PMCID: PMC6483409 DOI: 10.1590/1678-9199-jvatitd-1481-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/17/2018] [Indexed: 01/26/2023] Open
Abstract
Scorpion venoms are natural sources of molecules that have, in addition to their
toxic function, potential therapeutic applications. In this source the
neurotoxins can be found especially those that act on potassium channels.
Potassium channels are responsible for maintaining the membrane potential in the
excitable cells, especially the voltage-dependent potassium channels (Kv),
including Kv1.3 channels. These channels (Kv1.3) are expressed by various types
of tissues and cells, being part of several physiological processes. However,
the major studies of Kv1.3 are performed on T cells due its importance on
autoimmune diseases. Scorpion toxins capable of acting on potassium channels
(KTx), mainly on Kv1.3 channels, have gained a prominent role for their possible
ability to control inflammatory autoimmune diseases. Some of these toxins have
already left bench trials and are being evaluated in clinical trials, presenting
great therapeutic potential. Thus, scorpion toxins are important natural
molecules that should not be overlooked in the treatment of autoimmune and other
diseases.
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Affiliation(s)
- Isadora S Oliveira
- School of Pharmaceutical Sciences of Ribeirão Preto, Department of Physics and Chemistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Isabela G Ferreira
- School of Pharmaceutical Sciences of Ribeirão Preto, Department of Physics and Chemistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Felipe A Cerni
- Ribeirão Preto Medical School, Department of Biochemistry and Immunology, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Caroline M Cremonez
- School of Pharmaceutical Sciences of Ribeirão Preto, Department of Physics and Chemistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Eliane C Arantes
- School of Pharmaceutical Sciences of Ribeirão Preto, Department of Physics and Chemistry, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Umberto Zottich
- Medical School, Federal University of Roraima, Boa Vista, RR, Brazil
| | - Manuela B Pucca
- Medical School, Federal University of Roraima, Boa Vista, RR, Brazil
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10
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Gong Y, Zhao Y, Zhang X, Qi S, Li S, Ye Y, Yang J, Caulloo S, McElwee KJ, Zhang X. Serum level of
IL
‐4 predicts response to topical immunotherapy with diphenylcyclopropenone in alopecia areata. Exp Dermatol 2018; 29:231-238. [DOI: 10.1111/exd.13758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/08/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Yugang Gong
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
- Institute of Dermatology and VenereologySichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital Chengdu China
| | - Ying Zhao
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Xiaoting Zhang
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Shiling Qi
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Shuifeng Li
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Yanting Ye
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Jian Yang
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Sillani Caulloo
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | | | - Xingqi Zhang
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
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11
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Czarnowicki T, He HY, Wen HC, Hashim PW, Nia JK, Malik K, Estrada Y, Kimmel GW, Taliercio M, Krueger JG, Guttman-Yassky E. Alopecia areata is characterized by expansion of circulating Th2/Tc2/Th22, within the skin-homing and systemic T-cell populations. Allergy 2018; 73:713-723. [PMID: 29083474 DOI: 10.1111/all.13346] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Characterizing blood profile of alopecia areata (AA) is important not only for treatment advancements, but also for possibly identifying peripheral biomarkers that will eliminate the need for scalp biopsies. We aimed to compare frequencies of skin homing (CLA+ ) vs systemic (CLA- ) "polar" CD4+ and CD8+ and activated T-cell subsets in AA vs atopic dermatitis (AD) and control blood. METHODS Flow cytometry was used to measure IFN-γ, IL-13, IL-9, IL-17, and IL-22 cytokines in CD4+ and CD8+ T cells. Inducible co-stimulator molecule (ICOS) and HLA-DR were used to define mid- and long-term T-cell activation. We compared peripheral blood from 32 moderate-to-severe AA adults with 43 moderate-to-severe AD patients and 30 age-matched controls. RESULTS AA patients had increased CLA+ /CLA- Th2 (P < .007), CLA+ Tc2 (P = .04), and CLA+ Th22 (P < .05) frequencies than controls. Except of CLA- Tc1 cells (P = .03), IFN-γ levels were mostly similar between AA, AD, and controls (P > .1). ICOS and HLA-DR activation were significantly higher in AA than controls (P < .05). T regulatory cells were significantly decreased in AA patients than controls (P < .01) and were correlated with activated CD8+ T cells and with multiple cytokine subsets (P < .05). While Th2 and Tc2 clustered with disease severity, IFN-γ producing cells were linked with AA duration. CONCLUSIONS Alopecia areata is accompanied by Th2/Tc2 activation in skin-homing and systemic subsets, correlating with disease severity, while IFN-γ is linked to disease chronicity. These data hint for a possible role of diverse T-cells subsets in disease pathogenesis and emphasize the systemic nature of AA supporting the need for systemic therapeutic strategies in severe patients.
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Affiliation(s)
- T. Czarnowicki
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - H. Y. He
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - H.-C. Wen
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - P. W. Hashim
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - J. K. Nia
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - K. Malik
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
- SUNY Downstate College of Medicine; Brooklyn NY USA
| | - Y. Estrada
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - G. W. Kimmel
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Taliercio
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - J. G. Krueger
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - E. Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
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12
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Atwa MA, Youssef N, Bayoumy NM. T-helper 17 cytokines (interleukins 17, 21, 22, and 6, and tumor necrosis factor-α) in patients with alopecia areata: association with clinical type and severity. Int J Dermatol 2016; 55:666-72. [PMID: 26235375 DOI: 10.1111/ijd.12808] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/30/2014] [Accepted: 07/07/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an organ-specific autoimmune disease characterized by T-cell infiltrates and cytokine production. T-helper 17 (Th17) cells are crucially involved in the pathogenesis of autoimmune diseases. OBJECTIVES Our aim was to assess the association of Th17 with AA. We examined interleukin (IL)-17, IL-21, IL-22, IL-6, and tumor necrosis factor-alpha (TNF-α) levels in the serum of patients with AA and studied their association with clinical type and severity of AA. SUBJECTS AND METHODS The serum concentrations of IL-17, IL-21, IL-22, IL-6, and TNF-α were measured in 47 patients with AA and 40 healthy controls. The clinical type of AA was determined, and the severity of hair loss was assessed in accordance with the Alopecia Areata Investigational Assessment Guideline criteria. RESULTS The serum concentrations of IL-17, IL-21, IL-22, IL-6, and TNF-α were significantly higher in patients with AA as compared with healthy controls (mean: IL-17 33.23 ± 11.58 vs. 4.62 ± 1.88 pg/ml; P = 0.000, IL-21 62.10 ± 6.11 vs. 48.38 ± 3.31 pg/ml; P = 0.000, IL-22 19.27 ± 3.36 vs. 7.09 ± 1.62 pg/ml; P = 0.000, IL-6 17.18 ± 3.08 vs. 4.59 ± 1.66 pg/ml; P = 0.000, TNF-α 19.94 ± 3.59 vs. 9.95 ± 2.42 pg/ml; P = 0.000, respectively). There were significant positive correlations between serum IL-17, TNF-α, and disease severity. There was also significant positive correlation between serum IL-22 and duration of AA. CONCLUSION Our results showed high serum levels of Th17 cytokines among patients with AA that may suggest a functional role of these cytokines in the pathogenesis of this important skin disease. It could also provide the rationale for new treatment strategies in AA.
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Affiliation(s)
- Mona A Atwa
- Department of Dermatology and Venereology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nahed Youssef
- Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nervana M Bayoumy
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Phototherapy is a useful therapeutic method for various skin diseases due to its modulatory effect on the cutaneous immune system. Alopecia areata is a dermatosis characterized by partial or complete hair loss. Collapse of the immune privilege of the hair follicle, which induces noncicatricial alopecia, is an important factor in its etiology. Several forms of phototherapy are used in dermatology.
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Affiliation(s)
- Oliverio Welsh
- Depatment of Dermatology, University Hospital, Universidad Autonoma de Nuevo Leon, Avenida Francisco I. Madero y GonzalitoS S/N, Mitras Centro, Monterrey, NL, 64460, Mexico.
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Gilhar A, Schrum AG, Etzioni A, Waldmann H, Paus R. Alopecia areata: Animal models illuminate autoimmune pathogenesis and novel immunotherapeutic strategies. Autoimmun Rev 2016; 15:726-35. [PMID: 26971464 DOI: 10.1016/j.autrev.2016.03.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/02/2016] [Indexed: 01/13/2023]
Abstract
One of the most common human autoimmune diseases, alopecia areata (AA), is characterized by sudden, often persisting and psychologically devastating hair loss. Animal models have helped greatly to elucidate critical cellular and molecular immune pathways in AA. The two most prominent ones are inbred C3H/HeJ mice which develop an AA-like hair phenotype spontaneously or after experimental induction, and healthy human scalp skin xenotransplanted onto SCID mice, in which a phenocopy of human AA is induced by injecting IL-2-stimulated PBMCs enriched for CD56+/NKG2D+ cells intradermally. The current review critically examines the pros and cons of the available AA animal models and how they have shaped our understanding of AA pathobiology, and the development of new therapeutic strategies. AA is thought to arise when the hair follicle's (HF) natural immune privilege (IP) collapses, inducing ectopic MHC class I expression in the HF epithelium and autoantigen presentation to autoreactive CD8+ T cells. In common with other autoimmune diseases, upregulation of IFN-γ and IL-15 is critically implicated in AA pathogenesis, as are NKG2D and its ligands, MICA, and ULBP3. The C3H/HeJ mouse model was used to identify key immune cell and molecular principles in murine AA, and proof-of-principle that Janus kinase (JAK) inhibitors are suitable agents for AA management in vivo, since both IFN-γ and IL-15 signal via the JAK pathway. Instead, the humanized mouse model of AA has been used to demonstrate the previously hypothesized key role of CD8+ T cells and NKG2D+ cells in AA pathogenesis and to discover human-specific pharmacologic targets like the potassium channel Kv1.3, and to show that the PDE4 inhibitor, apremilast, inhibits AA development in human skin. As such, AA provides a model disease, in which to contemplate general challenges, opportunities, and limitations one faces when selecting appropriate animal models in preclinical research for human autoimmune diseases.
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Affiliation(s)
- Amos Gilhar
- Skin Research Laboratory, Faculty of Medicine, Technion - Israel Institute of Technology, Flieman Medical Center, PO Box 9649, Haifa, Israel.
| | - Adam G Schrum
- Department of Immunology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Amos Etzioni
- Ruth Children Hospital, Haifa, Israel; Rappaport Medical School, Technion, Haifa, Israel
| | - Herman Waldmann
- Therapeutic Immunology Group, Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Ralf Paus
- Centre for Dermatology Research, Inst. of Inflammation and Repair, University of Manchester, Manchester, UK; Department of Dermatology, University of Münster, Münster, Germany
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15
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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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16
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Ito T, Tokura Y. The role of cytokines and chemokines in the T-cell-mediated autoimmune process in alopecia areata. Exp Dermatol 2014; 23:787-91. [DOI: 10.1111/exd.12489] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Taisuke Ito
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
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17
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Recent advances in the pathogenesis of autoimmune hair loss disease alopecia areata. Clin Dev Immunol 2013; 2013:348546. [PMID: 24151515 PMCID: PMC3789320 DOI: 10.1155/2013/348546] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/19/2013] [Indexed: 01/04/2023]
Abstract
Alopecia areata is considered to be a cell-mediated autoimmune disease, in which autoreactive cytotoxic T cells recognize melanocyte-associated proteins such as tyrosinase. This review discusses recent advances in the understanding of the pathogenesis of alopecia areata, focusing on immunobiology and hormonal aspects of hair follicles (HFs). The HF is a unique “miniorgan” with its own immune and hormonal microenvironment. The immunosuppressive milieu of the anagen hair bulb modulated by immunosuppressive factors is known as “hair follicle immune privilege.” The collapse of the hair follicle immune privilege leads to autoimmune reactions against hair follicle autoantigens. Alopecia areata is sometimes triggered by viral infections such as influenza that causes excess production of interferons (IFN). IFN-γ is one of the key factors that lead to the collapse of immune privilege. This paper reviews the interactions between the endocrine and immune systems and hair follicles in the pathogenesis of alopecia areata.
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18
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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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19
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The association between Interleukin (IL)-4 gene intron 3 VNTR polymorphism and alopecia areata (AA) in Turkish population. Gene 2013; 527:565-9. [DOI: 10.1016/j.gene.2013.05.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/17/2013] [Accepted: 05/29/2013] [Indexed: 01/23/2023]
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20
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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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21
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Ito T, Hashizume H, Shimauchi T, Funakoshi A, Ito N, Fukamizu H, Takigawa M, Tokura Y. CXCL10 produced from hair follicles induces Th1 and Tc1 cell infiltration in the acute phase of alopecia areata followed by sustained Tc1 accumulation in the chronic phase. J Dermatol Sci 2013; 69:140-7. [DOI: 10.1016/j.jdermsci.2012.12.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 11/16/2022]
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22
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Zhao M, Liang G, Wu X, Wang S, Zhang P, Su Y, Yin H, Tan Y, Zhang J, Lu Q. Abnormal epigenetic modifications in peripheral blood mononuclear cells from patients with alopecia areata. Br J Dermatol 2012; 166:226-73. [PMID: 21936853 DOI: 10.1111/j.1365-2133.2011.10646.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a hair loss disease caused by T-cell-mediated autoimmune reactions against anagen-stage hair follicles. Although the exact aetiology is poorly understood, there is evidence to suggest that both genetic and environmental factors are involved in AA pathogenesis. OBJECTIVES To analyse DNA methylation and histone modification patterns in peripheral blood mononuclear cells (PBMCs) of patients with AA. METHODS PBMC samples were obtained from 25 patients with AA and 20 healthy controls. Global DNA methylcytosine levels, as well as histone acetylation and methylation levels, were measured by enzyme-linked immunosorbent assay. mRNA expression levels were determined using real-time quantitative reverse transcription-polymerase chain reaction. RESULTS Genomic DNA methylation in PBMCs of patients with AA was increased relative to controls. DNMT1, MBD1 and MBD4 expression levels were significantly higher in AA PBMCs than in controls, and DNMT1 transcription levels positively correlated with global DNA methylation levels in patient samples. Histone H3 acetylation was significantly increased and histone H3 lysine 4 methylation was significantly decreased in patient PBMCs compared with healthy controls. Histone H3 acetylation levels were positively correlated with AA disease severity, and with RANTES (CCL5) mRNA expression in PBMCs of patients with AA. These changes were accompanied by increased p300 (EP300), histone deacetylase 1 (HDAC1), myeloid/lymphoid or mixed lineage leukemia (MLL), SET7/9 (SETD7), G9A (EHMT2), JMJD2C (KDM4C) and JARID1A (KDM5A) expression, as well as reduced HDAC2, HDAC7, LSD1 (KDM1A), JMJD2A (KDM4A) and JMJD2B (KDM4B) expression. CONCLUSIONS DNA methylation and histone modification status are altered in PBMCs of patients with AA, possibly due to the deregulation of epigenetic regulatory genes. These changes may contribute to the activation of pathological immune responses in AA.
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Affiliation(s)
- M Zhao
- Hunan Key Laboratory of Medical Epigenomics, Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan 410011, China
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23
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Alli R, Nguyen P, Boyd K, Sundberg JP, Geiger TL. A mouse model of clonal CD8+ T lymphocyte-mediated alopecia areata progressing to alopecia universalis. THE JOURNAL OF IMMUNOLOGY 2011; 188:477-86. [PMID: 22116824 DOI: 10.4049/jimmunol.1100657] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Alopecia areata is among the most prevalent autoimmune diseases, yet compared with other autoimmune conditions, it is not well studied. This in part results from limitations in the C3H/HeJ mouse and DEBR rat model systems most commonly used to study the disease, which display a low frequency and late onset. We describe a novel high-incidence model for spontaneous alopecia areata. The 1MOG244 T cell expresses dual TCRA chains, one of which, when combined with the single TCRB present, promotes the development of CD8(+) T cells with specificity for hair follicles. Retroviral transgenic mice expressing this TCR develop spontaneous alopecia areata at nearly 100% incidence. Disease initially follows a reticular pattern, with regionally cyclic episodes of hair loss and regrowth, and ultimately progresses to alopecia universalis. Alopecia development is associated with CD8(+) T cell activation, migration into the intrafollicular region, and hair follicle destruction. The disease may be adoptively transferred with T lymphocytes and is class I and not class II MHC-dependent. Pathologic T cells primarily express IFNG and IL-17 early in disease, with dramatic increases in cytokine production and recruitment of IL-4 and IL-10 production with disease progression. Inhibition of individual cytokines did not significantly alter disease incidence, potentially indicating redundancy in cytokine responses. These results therefore characterize a new high-incidence model for alopecia areata in C57BL/6J mice, the first to our knowledge to apply a monoclonal TCR, and indicate that class I MHC-restricted CD8(+) T lymphocytes can independently mediate the pathologic response.
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Affiliation(s)
- Rajshekhar Alli
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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24
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Costanzo A, Chimenti MS, Botti E, Caruso R, Sarra M, Monteleone G. IL-21 in the pathogenesis and treatment of skin diseases. J Dermatol Sci 2010; 60:61-6. [PMID: 20888735 DOI: 10.1016/j.jdermsci.2010.08.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 08/27/2010] [Indexed: 11/24/2022]
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25
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Petukhova L, Duvic M, Hordinsky M, Norris D, Price V, Shimomura Y, Kim H, Singh P, Lee A, Chen WV, Meyer KC, Paus R, Jahoda CAB, Amos CI, Gregersen PK, Christiano AM. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature 2010; 466:113-7. [PMID: 20596022 DOI: 10.1038/nature09114] [Citation(s) in RCA: 533] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 04/22/2010] [Indexed: 12/18/2022]
Abstract
Alopecia areata (AA) is among the most highly prevalent human autoimmune diseases, leading to disfiguring hair loss due to the collapse of immune privilege of the hair follicle and subsequent autoimmune attack. The genetic basis of AA is largely unknown. We undertook a genome-wide association study (GWAS) in a sample of 1,054 cases and 3,278 controls and identified 139 single nucleotide polymorphisms that are significantly associated with AA (P <or= 5 x 10(-7)). Here we show an association with genomic regions containing several genes controlling the activation and proliferation of regulatory T cells (T(reg) cells), cytotoxic T lymphocyte-associated antigen 4 (CTLA4), interleukin (IL)-2/IL-21, IL-2 receptor A (IL-2RA; CD25) and Eos (also known as Ikaros family zinc finger 4; IKZF4), as well as the human leukocyte antigen (HLA) region. We also find association evidence for regions containing genes expressed in the hair follicle itself (PRDX5 and STX17). A region of strong association resides within the ULBP (cytomegalovirus UL16-binding protein) gene cluster on chromosome 6q25.1, encoding activating ligands of the natural killer cell receptor NKG2D that have not previously been implicated in an autoimmune disease. By probing the role of ULBP3 in disease pathogenesis, we also show that its expression in lesional scalp from patients with AA is markedly upregulated in the hair follicle dermal sheath during active disease. This study provides evidence for the involvement of both innate and acquired immunity in the pathogenesis of AA. We have defined the genetic underpinnings of AA, placing it within the context of shared pathways among autoimmune diseases, and implicating a novel disease mechanism, the upregulation of ULBP ligands, in triggering autoimmunity.
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Affiliation(s)
- Lynn Petukhova
- Department of Dermatology, Columbia University, New York, New York 10032, USA
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Barahmani N, Lopez A, Babu D, Hernandez M, Donley SE, Duvic M. Serum T helper 1 cytokine levels are greater in patients with alopecia areata regardless of severity or atopy. Clin Exp Dermatol 2010; 35:409-16. [DOI: 10.1111/j.1365-2230.2009.03523.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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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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Katsinelos P, Kountouras J, Paroutoglou G, Zavos C. Alopecia areata, primary sclerosing cholangitis, and ulcerative colitis: autoimmunity and apoptosis as common links? Dig Dis Sci 2007; 52:1288-92. [PMID: 17372831 DOI: 10.1007/s10620-006-9265-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 02/13/2006] [Indexed: 12/13/2022]
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Kaelin U, Hassan AS, Braathen LR, Yawalkar N. Treatment of alopecia areata partim universalis with efalizumab. J Am Acad Dermatol 2006; 55:529-32. [PMID: 16908369 DOI: 10.1016/j.jaad.2006.05.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 04/28/2006] [Accepted: 05/30/2006] [Indexed: 11/17/2022]
Abstract
Alopecia areata (AA) is considered an autoimmune disease targeted at hair follicles with T-lymphocytes playing an important role in the pathogenesis. Treatment of AA, particularly the totalis and universalis subtypes, is often difficult and remains a therapeutic challenge. Novel biologic therapies that have been developed for the treatment of other immune-mediated inflammatory skin diseases may represent a new therapeutic modality for this disease. Efalizumab is a humanized monoclonal anti-CD11a antibody that inhibits T-cell activation and migration. We report a case of a 19-year-old man suffering from AA partim universalis, treated with efalizumab monotherapy. The treatment was well tolerated with no reported side effects. The striking improvement warrants further studies with this biologic therapy in AA.
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Affiliation(s)
- Ursula Kaelin
- From the Department of Dermatology, University of Bern
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Gupta P, Freyschmidt-Paul P, Vitacolonna M, Kiessling S, Hummel S, Hildebrand D, Marhaba R, Zöller M. A Chronic Contact Eczema Impedes Migration of Antigen-Presenting Cells in Alopecia Areata. J Invest Dermatol 2006; 126:1559-73. [PMID: 16675965 DOI: 10.1038/sj.jid.5700328] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Long-lasting allergen treatment is the most efficient therapy in alopecia areata (AA). The underlying mechanism is unknown. We here asked whether treatment with a contact sensitizer influences leukocyte migration such that dendritic cell (DC) migration or the recruitment of activated T-cells towards the skin become hampered. Allergen treatment of AA mice was not accompanied by a decrease in skin-infiltrating leukocytes or draining lymph node cells (LNC). However, the distribution of leukocyte subsets was changed with a dominance of monocytes in the skin and a reduced percentage of DCs in draining nodes. Chemokine and chemokine receptor expression in skin and draining nodes was strikingly increased and LNC from untreated and allergen-treated AA mice showed high migratory activity in vitro and readily homed in draining nodes and skin after intravenous injection. However, FITC labelling of the skin and subcutaneous transfer of dye-labelled DC revealed that allergen treatment created a chemokine milieu severely hampering DC migration from the skin towards the draining node. An allergic eczema-induced reduction in DC migration and antigen transfer could well contribute to insufficient T-cell activation and the recovery of hair follicle in AA and possibly be of relevance for other skin-related autoimmune diseases.
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Affiliation(s)
- Pooja Gupta
- Department of Tumor Progression and Tumor Defense, German Cancer Research Center, Heidelberg, Germany
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31
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Nagai H, Oniki S, Oka M, Horikawa T, Nishigori C. Induction of cellular immunity against hair follicle melanocyte causes alopecia. Arch Dermatol Res 2006; 298:131-4. [PMID: 16786344 DOI: 10.1007/s00403-006-0668-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 02/04/2006] [Accepted: 05/19/2006] [Indexed: 01/08/2023]
Abstract
Alopecia areata (AA) is generally regarded as an organ-specific autoimmune disease. Although it has been hypothesized that the autoimmunity is mediated by T cells and that hair follicle melanocyte is one of the targets, definitive evidence is lacking. We here demonstrate that AA-like lesions can be induced in mice by inducing CD8(+) T-cell-mediated immunity to hair follicle melanocytes. We found that hair loss was induced in mice-bearing interleukin-12-producing B16 melanoma cells by the depletion of CD4(+) T cells, accompanied by vitiligo-like coat color change. The alopecic lesions varied in size from pachy to extensive. In many instances, hair loss developed and was followed by the regrowth of white hairs. Histological analysis revealed that mononuclear cells infiltrated in and around the bulb region of hair follicles. Furthermore, immunohistochemical examination clearly showed the intra-follicular infiltration of CD8(+) T cells. Neither the vitiligo-like coat color nor AA-like lesions were induced when CD8(+) T cells were codepleted. These observations indicate that the induction of CD8(+) T-cell-mediated immunity against hair follicle melanocytes causes alopecia. It is thought that there are many types of AA with different mechanisms, targets etc. Although hair follicle melanocytes have long been thought to be one of the targets of AA, evidence to support the hypothesis is sparse. Therefore, we believe that our observation is significant to support the hypothesis.
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Affiliation(s)
- Hiroshi Nagai
- Department of Dermatology, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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32
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Igney FH, Asadullah K, Zollner TM. Humanised mouse models in drug discovery for skin inflammation. Expert Opin Drug Discov 2006; 1:53-68. [DOI: 10.1517/17460441.1.1.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Deeths MJ, Endrizzi BT, Irvin ML, Steiner LP, Ericson ME, Hordinsky MK. Phenotypic analysis of T-cells in extensive alopecia areata scalp suggests partial tolerance. J Invest Dermatol 2006; 126:366-73. [PMID: 16374469 DOI: 10.1038/sj.jid.5700054] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study demonstrates the feasibility and efficacy of using flow cytometric analysis with intracellular cytokine staining for characterization of T-cell phenotype and functional status in extensive alopecia areata (EAA) scalp skin. Cell suspensions were made from scalp punch biopsies taken from 12 patients with long-standing EAA (average disease duration 14 years, 95% hair loss) and six control subjects. EAA samples had a lower percentage of CD-3-expressing cells, but CD-4/CD-8 ratios remained similar to controls. Expression of CD-69 was found only in EAA scalp biopsies, suggesting that T-cells from EAA scalp have undergone activation. No difference was found in tumor necrosis factor alpha expression. Surprisingly, EAA scalp T-cells produced less IL-2 and CD-8 T-cells produced less IFN-gamma. Immunohistochemical staining of formalin-fixed paraffin-embedded specimens demonstrated that IFN-gamma-producing cells in EAA scalp were not greater in number than in normal specimens. The few identified IFN-gamma-producing cells demonstrated no tendency to localize to the perifollicular region, and were similarly distributed as in control specimens. The abnormalities in cytokine production may explain the relative paucity of inflammatory change observed in the clinical setting and suggest that T-cell responses in EAA scalp are tightly, albeit aberrantly, regulated via mechanisms of peripheral T-cell tolerance.
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Affiliation(s)
- Matthew J Deeths
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
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Gilhar A, Kalish RS. Alopecia Areata: A tissue specific autoimmune disease of the hair follicle. Autoimmun Rev 2006; 5:64-9. [PMID: 16338213 DOI: 10.1016/j.autrev.2005.07.001] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Accepted: 07/05/2005] [Indexed: 01/03/2023]
Abstract
The goal of this review is to introduce the immunologic community to alopecia areata as a model system for the study of tissue directed autoimmune disease. Alopecia areata is marked by autoimmune assault on the hair follicle resulting in hair loss. It is linked to HLA-DQ3 and evidence suggests it is mediated by T-lymphocytes with a TH1 cytokine profile. Hair follicles are an immune protected site with deficient MHC expression. Evidence is presented suggesting that alopecia areata results from loss of immune privilege with presentation of autoantigens. Alopecia areata is one of the most common human autoimmune conditions, with a lifetime risk of approximately 1.7%. Study of alopecia areata in humans is facilitated by the accessibility of scalp for biopsy. It is possible to transfer the condition with lesional human lymphocytes in a human scalp graft/SCID mouse model. There are also spontaneous animal models which share the features of the human condition. For these reasons, alopecia areata is a powerful model for study of the induction and pathogenesis of tissue directed autoimmune disease.
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Affiliation(s)
- Amos Gilhar
- Laboratory for Skin Research, Rappaport Building, Technion Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Flieman Med Center, P.O.B. 9649, Bat-Galim, Haifa, 31096, Israel.
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Freyschmidt-Paul P, Happle R, Hoffman R. [Alopecia areata in animal models--new insights into pathogenesis and treatment of a T cell-mediated autoimmune disorder]. J Dtsch Dermatol Ges 2005; 2:260-73. [PMID: 16285322 DOI: 10.1046/j.1610-0387.2003.03553.x-i1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Alopecia areata is a common disease, but for ethical reasons it seems difficult to perform large-scale studies to elucidate the pathogenesis and to develop new therapeutic approaches in man. It is therefore helpful to develop appropriate animal models. The Dundee experimental bald rat (DEBR) and the C3H/HeJ mouse are well-established animal models for alopecia areata and can be used for the study of genetic aspects, pathogenesis and therapy of the disease. In C3H/HeJ mice alopecia areata can be experimentally induced by grafting lesional skin from an affected mouse to a histocompatible recipient which offers the possibility to study the influence of various factors on the development of the disease. Studies on the C3H/HeJ mouse and the DEBR have corroborated the concept that alopecia areata is a T-cell mediated autoimmune disease and various steps and aspects of the pathogenesis have been elucidated. Based on this knowledge new therapeutic options may be developed such as inhibition of lymphocyte-homing by an anti-CD44v10 antibody, or inhibition of costimulation by monoclonal antibodies. Therapeutic studies in the C3H/HeJ mouse and the DEBR suggest that alopecia areata can be treated by topical tacrolimus but treatment in humans may only be successful after development of an improved vehicle that facilitates penetration of tacrolimus down to the hair bulb. Current investigations in mice are designed to elucidate the mechanisms how contact sensitizers act in the treatment of alopecia areata, and this will hopefully lead to the development of more specific approaches based on the beneficial effect of contact sensitizers.
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Okamoto M, Ogawa Y, Watanabe A, Sugiura K, Shimomura Y, Aoki N, Nagasaka T, Tomita Y, Muro Y. Autoantibodies to DFS70/LEDGF are increased in alopecia areata patients. J Autoimmun 2005; 23:257-66. [PMID: 15501396 DOI: 10.1016/j.jaut.2004.07.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Revised: 06/29/2004] [Accepted: 07/12/2004] [Indexed: 11/19/2022]
Abstract
Alopecia areata (AA) has been suspected to be an autoimmune disease, although there is no distinct evidence, we investigated the relationship between AA and autoantibodies against dense fine speckles 70 kDa (DFS70) in 111 patients with alopecia and 105 healthy controls. The sera from 59 out of 111 (53%) Japanese alopecia patients were positive for anti-nuclear antibody (ANA), as compared to the sera of 16 out of 105 (15%) healthy controls (p < 0.001). Twenty percent (22/111) of the alopecia patients were shown to be positive for the prevalence of anti-DFS70 antibodies, as compared to 8% (8/105) of the healthy controls (p < 0.01). IgG subclass analysis by ELISA showed that IgG1 and IgG2-anti-DFS70 antibodies were dominant in alopecia patients. The DFS70 gene expression in the hair structures was clearly detected in both those with and those without the anti-DFS70 antibody by RT-PCR. Immunohistochemical techniques showed that the DFS70 was localized predominantly in the outer root sheath (ORS) cells. The elevated anti-DFS70 antibodies in alopecia patients and the localization of the DFS70 in the ORS suggest that autoantibodies against the DFS70 are related to the etiology in a certain population of AA.
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Affiliation(s)
- Miyako Okamoto
- Division of Connective Tissue Disease & Autoimmunity, Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Gilhar A, Kam Y, Assy B, Kalish RS. Alopecia areata induced in C3H/HeJ mice by interferon-gamma: evidence for loss of immune privilege. J Invest Dermatol 2005; 124:288-9. [PMID: 15654992 DOI: 10.1111/j.0022-202x.2004.23580.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Igney FH, Asadullah K, Zollner TM. Techniques: species' finest blend--humanized mouse models in inflammatory skin disease research. Trends Pharmacol Sci 2004; 25:543-9. [PMID: 15380939 DOI: 10.1016/j.tips.2004.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Differences between humans and mice often hamper the transfer of promising results from the bench to the clinic. For ethical reasons, research that involves patients is limited, and so there is an urgent need for models that mimic the human situation as closely as possible. In recent years, there has been considerable progress in generating humanized mouse models, and their application to drug discovery has proved fruitful. So, how can mice be humanized, and how can humanized mice be employed in immunology research and drug discovery? In this article, we answer these questions, focusing on T-cell-mediated skin diseases as an example.
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Hequet O, Vocanson M, Saint-Mézard P, Kaiserlian D, Nicolas JF, Bérard F. CD4+ T cells prevent skin autoimmunity during chronic autologous graft-versus-host-disease. Am J Transplant 2004; 4:872-8. [PMID: 15147420 DOI: 10.1111/j.1600-6143.2004.00439.x] [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: 01/25/2023]
Abstract
CD4 regulatory cells have been postulated to prevent autologous graft-vs.-host disease (GVHD). In order to test this hypothesis, we used BALB/c mice, a strain known to be resistant to autologous GVHD, which had received autologous stem cell transplantation (ASCT) and cyclosporine A (CsA). As expected, ASCT/CsA-treated BALB/c mice did not develop any sign of acute or chronic GVHD. However, depletion of CD4 T cells induced a skin disease with clinical and histological features of alopecia areata (AA), a CD8 T-cell-mediated human autoimmune skin disease. The hair loss in mice developing AA was associated with the infiltration of the skin by activated CD8 T cells. Analysis of the T-cell recovery in ASCT- and ASCT/CsA-treated mice showed that CsA induced an increase in the number of CD4+ 25+ T cells, suggesting that the lack of GVHD in ASCT/CsA treated-mice could be related to the expansion of this CD4 T-cell subset. Collectively these data show that CD4 T cells comprise regulatory cells controlling the onset of autologous GVHD and suggest that the naturally occurring CD4+ 25+ subset may be responsible for this effect.
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Benoit S, Toksoy A, Goebeler M, Gillitzer R. Selective Expression of Chemokine Monokine Induced by Interferon-γ in Alopecia Areata. J Invest Dermatol 2003; 121:933-5. [PMID: 14632215 DOI: 10.1046/j.1523-1747.2003.12524.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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