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Šutić Udović I, Hlača N, Massari LP, Brajac I, Kaštelan M, Vičić M. Deciphering the Complex Immunopathogenesis of Alopecia Areata. Int J Mol Sci 2024; 25:5652. [PMID: 38891839 PMCID: PMC11172390 DOI: 10.3390/ijms25115652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient's quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis.
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Affiliation(s)
| | | | - Larisa Prpić Massari
- Department of Dermatovenereology, Clinical Hospital Centre Rijeka, Medical Faculty, University of Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; (I.Š.U.); (N.H.); (I.B.); (M.K.); (M.V.)
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Touil H, Mounts K, De Jager PL. Differential impact of environmental factors on systemic and localized autoimmunity. Front Immunol 2023; 14:1147447. [PMID: 37283765 PMCID: PMC10239830 DOI: 10.3389/fimmu.2023.1147447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
The influence of environmental factors on the development of autoimmune disease is being broadly investigated to better understand the multifactorial nature of autoimmune pathogenesis and to identify potential areas of intervention. Areas of particular interest include the influence of lifestyle, nutrition, and vitamin deficiencies on autoimmunity and chronic inflammation. In this review, we discuss how particular lifestyles and dietary patterns may contribute to or modulate autoimmunity. We explored this concept through a spectrum of several autoimmune diseases including Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE) and Alopecia Areata (AA) affecting the central nervous system, whole body, and the hair follicles, respectively. A clear commonality between the autoimmune conditions of interest here is low Vitamin D, a well-researched hormone in the context of autoimmunity with pleiotropic immunomodulatory and anti-inflammatory effects. While low levels are often correlated with disease activity and progression in MS and AA, the relationship is less clear in SLE. Despite strong associations with autoimmunity, we lack conclusive evidence which elucidates its role in contributing to pathogenesis or simply as a result of chronic inflammation. In a similar vein, other vitamins impacting the development and course of these diseases are explored in this review, and overall diet and lifestyle. Recent work exploring the effects of dietary interventions on MS showed that a balanced diet was linked to improvement in clinical parameters, comorbid conditions, and overall quality of life for patients. In patients with MS, SLE and AA, certain diets and supplements are linked to lower incidence and improved symptoms. Conversely, obesity during adolescence was linked with higher incidence of MS while in SLE it was associated with organ damage. Autoimmunity is thought to emerge from the complex interplay between environmental factors and genetic background. Although the scope of this review focuses on environmental factors, it is imperative to elaborate the interaction between genetic susceptibility and environment due to the multifactorial origin of these disease. Here, we offer a comprehensive review about the influence of recent environmental and lifestyle factors on these autoimmune diseases and potential translation into therapeutic interventions.
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Affiliation(s)
- Hanane Touil
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Kristin Mounts
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Philip Lawrence De Jager
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
- Columbia Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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Jadeja SD, Tobin DJ. Autoantigen Discovery in the Hair Loss Disorder, Alopecia Areata: Implication of Post-Translational Modifications. Front Immunol 2022; 13:890027. [PMID: 35720384 PMCID: PMC9205194 DOI: 10.3389/fimmu.2022.890027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022] Open
Abstract
Alopecia areata (AA) is a chronic, multifactorial, polygenic, and heterogeneous disorder affecting growing hair follicles in susceptible individuals, which results in a non-scarring and reversible hair loss with a highly unpredictable course. Despite very considerable research effort, the nature of the precipitating factor(s) responsible for initiating AA in any given hair follicle remains unclear, due largely to significant gaps in our knowledge of the precise sequence of the etiopathogenic events in this dermatosis. However, disease-related changes in the immune-competence of the lower growing hair follicle, together with an active immune response (humoral and cellular) to hair follicle-associated antigens, are key associated phenomena. Confirmation of the hair follicle antigen(s) implicated in AA disease onset has remained stubbornly elusive. While it may be considered somewhat philosophical by some, it is also unclear whether immune-mediated hair loss in AA results from a) an ectopic (i.e., in an abnormal location) immune response to native (unmodified) self-antigens expressed by the healthy hair follicle, b) a normal immune response against modified self-antigens (or neoantigens), or c) a normal immune response against self-antigens (modified/non-modified) that were not previously visible to the immune system (because they were conformationally-hidden or sequestered) but become exposed and presentable in an MHC-I/-II molecule-restricted manner. While some candidate hair follicle antigen target(s) in AA are beginning to emerge, with a potential role for trichohyalin, it is not yet clear whether this represents the initial and immunodominant antigenic focus in AA or is simply one of an expanding repertoire of exposed hair follicle tissue damage-associated antigens that are secondary to the disease. Confirmation of autoantigen identity is essential for our understanding of AA etiopathogenesis, and consequently for developing a more informed therapeutic strategy. Major strides have been made in autoantigen discovery in other autoimmune conditions. In particular, some of these conditions may provide insights into how post-translational modifications (e.g., citrullination, deamidation, etc.) of hair follicle-restricted proteins may increase their antigenicity and so help drive the anti-hair follicle immune attack in AA.
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Affiliation(s)
- Shahnawaz D. Jadeja
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Desmond J. Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
- The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
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Watson VE, Faniel ML, Kamili NA, Krueger LD, Zhu C. Immune-mediated alopecias and their mechanobiological aspects. Cells Dev 2022; 170:203793. [PMID: 35649504 PMCID: PMC10681075 DOI: 10.1016/j.cdev.2022.203793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/24/2022] [Indexed: 02/06/2023]
Abstract
Alopecia is a non-specific term for hair loss clinically diagnosed by the hair loss pattern and histological analysis of patient scalp biopsies. The immune-mediated alopecia subtypes, including alopecia areata, lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia, are common, significant forms of alopecia subtypes. For example, alopecia areata is the most common autoimmune disease with a lifetime incidence of approximately 2% of the world's population. In this perspective, we discuss major results from studies of immune-mediated alopecia subtypes. These studies suggest the key event in disease onset as the collapse in immune privilege, which alters the hair follicle microenvironment, e.g., upregulation of major histocompatibility complex molecules and increase of cytokine production, and results in immune cell infiltration, inflammatory responses, and damage of hair follicles. We note that previous studies have established that the hair follicle has a complex mechanical microenvironment, which may regulate the function of not only tissue cells but also immune cell infiltrates. This suggests a potential for mechanobiology to contribute to alopecia research by adding new methods, new approaches, and new ways of thinking, which is missing in the existing literature. To fill this a gap in the alopecia research space, we develop a mechanobiological hypothesis that alterations in the hair follicle microenvironment, specifically in the mechanically responsive tissues and cells, partially due to loss of immune privilege, may be contributors to disease pathology. We further focus our discussion on the potential for applying mechanoimmunology to the study of T cell infiltrates in the hair follicle, as they are considered primary contributors to alopecia pathology. To establish the connection between the mechanoimmunological hypothesis and immune-mediated alopecia subtypes, we discuss what is known about the role of T cells in immune-mediated alopecia subtypes, using the most extensively studied AA as our model.
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Affiliation(s)
- Valencia E Watson
- Wallace H. Coulter Department of Biomedical Engineering, USA; Bioengineering PhD Program, USA; Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Makala L Faniel
- Wallace H. Coulter Department of Biomedical Engineering, USA; Bioengineering PhD Program, USA; Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Loren D Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Cheng Zhu
- Wallace H. Coulter Department of Biomedical Engineering, USA; Bioengineering PhD Program, USA; Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA.
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Zhao B, Luo H, He J, Huang X, Chen S, Fu X, Zeng W, Tian Y, Liu S, Li CJ, Liu GE, Fang L, Zhang S, Tian K. Comprehensive transcriptome and methylome analysis delineates the biological basis of hair follicle development and wool-related traits in Merino sheep. BMC Biol 2021; 19:197. [PMID: 34503498 PMCID: PMC8427949 DOI: 10.1186/s12915-021-01127-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Characterization of the molecular mechanisms underlying hair follicle development is of paramount importance in the genetic improvement of wool-related traits in sheep and skin-related traits in humans. The Merino is the most important breed of fine-wooled sheep in the world. In this study, we systematically investigated the complexity of sheep hair follicle development by integrating transcriptome and methylome datasets from Merino sheep skin. Results We analysed 72 sequence datasets, including DNA methylome and the whole transcriptome of four gene types, i.e. protein-coding genes (PCGs), lncRNAs, circRNAs, and miRNAs, across four embryonic days (E65, E85, E105, and E135) and two postnatal days (P7 and P30) from the skin tissue of 18 Merino sheep. We revealed distinct expression profiles of these four gene types across six hair follicle developmental stages, and demonstrated their complex interactions with DNA methylation. PCGs with stage-specific expression or regulated by stage-specific lncRNAs, circRNAs, and miRNAs were significantly enriched in epithelial differentiation and hair follicle morphogenesis. Regulatory network and gene co-expression analyses identified key transcripts controlling hair follicle development. We further predicted transcriptional factors (e.g. KLF4, LEF1, HOXC13, RBPJ, VDR, RARA, and STAT3) with stage-specific involvement in hair follicle morphogenesis. Through integrating these stage-specific genomic features with results from genome-wide association studies (GWAS) of five wool-related traits in 7135 Merino sheep, we detected developmental stages and genes that were relevant with wool-related traits in sheep. For instance, genes that were specifically upregulated at E105 were significantly associated with most of wool-related traits. A phenome-wide association study (PheWAS) demonstrated that candidate genes of wool-related traits (e.g. SPHK1, GHR, PPP1R27, CSRP2, EEF1A2, and PTPN1) in sheep were also significantly associated with dermatological, metabolic, and immune traits in humans. Conclusions Our study provides novel insights into the molecular basis of hair follicle morphogenesis and will serve as a foundation to improve breeding for wool traits in sheep. It also indicates the importance of studying gene expression in the normal development of organs in understanding the genetic architecture of economically important traits in livestock. The datasets generated here are useful resources for functionally annotating the sheep genome, and for elucidating early skin development in mammals, including humans. Supplementary Information The online version contains supplementary material available at 10.1186/s12915-021-01127-9.
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Affiliation(s)
- Bingru Zhao
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Hanpeng Luo
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Junmin He
- Key Laboratory of Genetics Breeding and Reproduction of the Fine Wool Sheep & Cashmere Goat in Xinjiang, Institute of Animal Science, Xinjiang Academy of Animal Sciences, Urumqi, China
| | - Xixia Huang
- College of Animal Science, Xinjiang Agricultural University, Urumqi, China
| | - Siqian Chen
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Xuefeng Fu
- Key Laboratory of Genetics Breeding and Reproduction of the Fine Wool Sheep & Cashmere Goat in Xinjiang, Institute of Animal Science, Xinjiang Academy of Animal Sciences, Urumqi, China
| | - Weidan Zeng
- College of Animal Science, Xinjiang Agricultural University, Urumqi, China
| | - Yuezhen Tian
- Key Laboratory of Genetics Breeding and Reproduction of the Fine Wool Sheep & Cashmere Goat in Xinjiang, Institute of Animal Science, Xinjiang Academy of Animal Sciences, Urumqi, China
| | - Shuli Liu
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Cong-Jun Li
- Animal Genomics and Improvement Laboratory, Henry A. Wallace Beltsville Agricultural Research Center, Agricultural Research Service, Agricultural Research Service, USDA, Beltsville, Maryland, USA
| | - George E Liu
- Animal Genomics and Improvement Laboratory, Henry A. Wallace Beltsville Agricultural Research Center, Agricultural Research Service, Agricultural Research Service, USDA, Beltsville, Maryland, USA
| | - Lingzhao Fang
- MRC Human Genetics Unit at the Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
| | - Shengli Zhang
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China.
| | - Kechuan Tian
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan, China.
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Abstract
Alopecia Areata is an inflammatory and T cell-mediated autoimmune reaction against unknown autoantigen of hair follicles characterized by patchy, non-scarring loss of hair follicles in the anagen phase. Although its etiology is minimally understood, genetic susceptibility, autoimmunity and stress are thought to be causative factors. It occurs in episodic and recurrent patterns with an incidence rate of 0.1-0.2% in the general population and 7-30 cases per 1000 dermatological patients with a lifetime risk of 1.7%. The lesions can be single and self-limiting or may be widespread. Autoimmune disorders such as Hashimoto's thyroiditis, Vitiligo, celiac disease, diabetes mellitus, psoriasis ad lupus erythematosus were observed as an associated comorbid disorder in AA patients, but hypothyroidism and Vitiligo have the strongest association. Its clinical course is unpredictable and shows no significant predilection to age, gender or race. AA is a heterogeneous variant of alopecia and has clinical types such as patchy alopecia, alopecia reticularis and alopecia totalis. Various epidemiological reports demonstrate an increased frequency of AA in thyroid disease patients. Contemporary research has shed spotlight on circulating auto-reactive cells in evolution of AA, which may play a role in ultimately linking these diseases. Comprehension of complex interplay between autoantigens and immune cells is still evolving. The present study will explore this association of Alopecia Areata in patients with thyroid dysfunction. This correlation was studied briefly with literature available in the medical database such as PubMed and Google Scholar.
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Affiliation(s)
- Piyu Parth Naik
- Department of Dermatology, Saudi-German Hospital & Clinic, Dubai, United Arab Emirates
| | - Syed Nadir Farrukh
- Department of Internal Medicine, Adam-Vital Hospital, Dubai, United Arab Emirates
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Zhao B, Luo H, Huang X, Wei C, Di J, Tian Y, Fu X, Li B, Liu GE, Fang L, Zhang S, Tian K. Integration of a single-step genome-wide association study with a multi-tissue transcriptome analysis provides novel insights into the genetic basis of wool and weight traits in sheep. Genet Sel Evol 2021; 53:56. [PMID: 34193030 PMCID: PMC8247193 DOI: 10.1186/s12711-021-00649-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/22/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Genetic improvement of wool and growth traits is a major goal in the sheep industry, but their underlying genetic architecture remains elusive. To improve our understanding of these mechanisms, we conducted a weighted single-step genome-wide association study (WssGWAS) and then integrated the results with large-scale transcriptome data for five wool traits and one growth trait in Merino sheep: mean fibre diameter (MFD), coefficient of variation of the fibre diameter (CVFD), crimp number (CN), mean staple length (MSL), greasy fleece weight (GFW), and live weight (LW). RESULTS Our dataset comprised 7135 individuals with phenotype data, among which 1217 had high-density (HD) genotype data (n = 372,534). The genotypes of 707 of these animals were imputed from the Illumina Ovine single nucleotide polymorphism (SNP) 54 BeadChip to the HD Array. The heritability of these traits ranged from 0.05 (CVFD) to 0.36 (MFD), and between-trait genetic correlations ranged from - 0.44 (CN vs. LW) to 0.77 (GFW vs. LW). By integrating the GWAS signals with RNA-seq data from 500 samples (representing 87 tissue types from 16 animals), we detected tissues that were relevant to each of the six traits, e.g. liver, muscle and the gastrointestinal (GI) tract were the most relevant tissues for LW, and leukocytes and macrophages were the most relevant cells for CN. For the six traits, 54 quantitative trait loci (QTL) were identified covering 81 candidate genes on 21 ovine autosomes. Multiple candidate genes showed strong tissue-specific expression, e.g. BNC1 (associated with MFD) and CHRNB1 (LW) were specifically expressed in skin and muscle, respectively. By conducting phenome-wide association studies (PheWAS) in humans, we found that orthologues of several of these candidate genes were significantly (FDR < 0.05) associated with similar traits in humans, e.g. BNC1 was significantly associated with MFD in sheep and with hair colour in humans, and CHRNB1 was significantly associated with LW in sheep and with body mass index in humans. CONCLUSIONS Our findings provide novel insights into the biological and genetic mechanisms underlying wool and growth traits, and thus will contribute to the genetic improvement and gene mapping of complex traits in sheep.
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Affiliation(s)
- Bingru Zhao
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Hanpeng Luo
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Xixia Huang
- College of Animal Science, Xinjiang Agricultural University, Urumqi, China
| | - Chen Wei
- College of Animal Science, Xinjiang Agricultural University, Urumqi, China
| | - Jiang Di
- Key Laboratory of Genetics Breeding and Reproduction of the Fine Wool Sheep & Cashmere Goat in Xinjiang, Institute of Animal Science, Xinjiang Academy of Animal Sciences, Urumqi, China
| | - Yuezhen Tian
- Key Laboratory of Genetics Breeding and Reproduction of the Fine Wool Sheep & Cashmere Goat in Xinjiang, Institute of Animal Science, Xinjiang Academy of Animal Sciences, Urumqi, China
| | - Xuefeng Fu
- Key Laboratory of Genetics Breeding and Reproduction of the Fine Wool Sheep & Cashmere Goat in Xinjiang, Institute of Animal Science, Xinjiang Academy of Animal Sciences, Urumqi, China
| | - Bingjie Li
- Scotland's Rural College (SRUC), Roslin Institute Building, Midlothian, EH25 9RG, UK
| | - George E Liu
- Animal Genomics and Improvement Laboratory, Henry A. Wallace Beltsville Agricultural Research Center, Agricultural Research Service, Agricultural Research Service, USDA, Beltsville, MD, USA
| | - Lingzhao Fang
- MRC Human Genetics Unit at the Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
| | - Shengli Zhang
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding, and Reproduction, Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing, China.
| | - Kechuan Tian
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan, China.
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Fernández LT, Kubelis-López DE, Muñoz-Garza FZ, Ocampo-Candiani J, Alba-Rojas EL. Hair flag sign: Macroscopic and trichoscopic feature of hair regrowth in alopecia areata. J Eur Acad Dermatol Venereol 2021; 35:e790-e792. [PMID: 34166541 DOI: 10.1111/jdv.17473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/24/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- L T Fernández
- Department of Dermatology, Hospital Universitario "Dr. José Eleuterio González,", Monterrey, México
| | - D E Kubelis-López
- Department of Dermatology, Hospital Universitario "Dr. José Eleuterio González,", Monterrey, México
| | - F Z Muñoz-Garza
- Department of Dermatology, Hospital Universitario "Dr. José Eleuterio González,", Monterrey, México
| | - J Ocampo-Candiani
- Department of Dermatology, Hospital Universitario "Dr. José Eleuterio González,", Monterrey, México
| | - E L Alba-Rojas
- Department of Dermatology, Hospital Universitario "Dr. José Eleuterio González,", Monterrey, México
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Abstract
Alopecia areata is a condition that affects hair follicles and leads to hair loss ranging from small well-defined patches to complete loss of all body hair. Despite its high incidence, the pathobiology is not fully understood, and no single concept could be universally accepted. Alopecia areata is mostly considered to be an autoimmune disease, in which the collapse of hair follicle immune privilege plays a key role. Higher incidence rate in the female population and increased overall risk of other autoimmune disorders militate in favor of autoimmune hypothesis. Antibodies against multiple components of hair follicles almost exclusively attack in anagen phase, where melanogenesis takes place. It suggests involvement of melanogenesis-associated autoantigens as a target epitope. Some investigators believed that alopecia areata is not a truly autoimmune disease but is only ‘consistent with’ autoimmune mechanisms. High frequency of a positive family history up to 42% may reflects the contribution of heredity factors. In addition, no specific target autoantigen has been identified so far, and autoantibodies to hair follicle-associated antigens are detectable in normal individuals.
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10
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Hamblin MR. Photobiomodulation for the management of alopecia: mechanisms of action, patient selection and perspectives. Clin Cosmet Investig Dermatol 2019; 12:669-678. [PMID: 31686888 PMCID: PMC6737896 DOI: 10.2147/ccid.s184979] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/13/2019] [Indexed: 01/10/2023]
Abstract
Photobiomodulation (PBM) or low-level laser therapy was discovered over 50 years ago, when Mester in Hungary observed regrowth of hair in mice when irradiated with a ruby laser. At the present time, several different PBM devices are marketed to assist with hair regrowth in alopecia patients. This review covers the three main types of alopecia (androgenetic, areata, and chemotherapy-induced), and discusses the mechanism of action of PBM for each disease. The different devices used (mostly low powered red laser diodes), dosimetry, animal models, and clinical trials are summarized. Criteria for patient selection are outlined. Finally a perspectives section looks forward to the future.
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Affiliation(s)
- Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.,Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
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11
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Abdel Halim D, Abu Zeid OM, Rashed L, Saleh MA. Alteration of serum and tissue tumor necrosis factor alpha levels: A possible mechanism of action of oral pulse steroids in the treatment of alopecia areata. J Cosmet Dermatol 2018; 18:1128-1132. [PMID: 30294905 DOI: 10.1111/jocd.12795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a multifactorial disease in which tumor necrosis factor alpha (TNF-α) plays an important role. OBJECTIVE To study the effect of oral pulse steroids on both serum and tissue levels of TNF-α in AA patients. METHODS Skin biopsies and serum samples were collected from 20 patients with patchy AA before and after treatment (oral prednisolone for two consecutive days every week for 3 months) for determination of the levels of TNF-α levels using ELISA technique. RESULTS Both serum and tissue levels of TNF-α in AA patients were significantly higher than in controls before (P < 0.001) as well as after treatment (P = 0.0169 and P = 0.3051), respectively. The duration of disease negatively correlated with tissue TNF-α before treatment (P < 0.0001). Serum and tissue levels of TNF-α dropped significantly after treatment (P < 0.0001). The percentage of reduction of both tissue and serum TNF-α levels correlated positively with the percentage of clinical improvement (r = 0.682, P = 0.0009; r = 0.567, P = 0.009, respectively). CONCLUSION TNF-α plays an important role in the evolution of AA lesions, and alteration in both serum and tissue levels of TNF-α could be considered one of the important mechanisms of action of systemic oral pulse steroids in the treatment of AA.
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Affiliation(s)
- Dalia Abdel Halim
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ola M Abu Zeid
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Laila Rashed
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwah Adly Saleh
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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de Jong A, Jabbari A, Dai Z, Xing L, Lee D, Li MM, Duvic M, Hordinsky M, Norris DA, Price V, Mackay-Wiggan J, Clynes R, Christiano AM. High-throughput T cell receptor sequencing identifies clonally expanded CD8+ T cell populations in alopecia areata. JCI Insight 2018; 3:121949. [PMID: 30282836 DOI: 10.1172/jci.insight.121949] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/29/2018] [Indexed: 01/04/2023] Open
Abstract
Alopecia areata (AA) is an autoimmune disease in which cytotoxic T cells specifically target growing hair follicles. We used high-throughput TCR sequencing in the C3H/HeJ mouse model of AA and in human AA patients to gain insight into pathogenic T cell populations and their dynamics, which revealed clonal CD8+ T cell expansions in lesional skin. In the C3H/HeJ model, we observed interindividual sharing of TCRβ chain protein sequences, which strongly supports a model of antigenic drive in AA. The overlap between the lesional TCR repertoire and a population of CD8+NKG2D+ T cells in skin-draining lymph nodes identified this subset as pathogenic effectors. In AA patients, treatment with the oral JAK inhibitor tofacitinib resulted in a decrease in clonally expanded CD8+ T cells in the scalp but also revealed that many expanded lesional T cell clones do not completely disappear from either skin or blood during treatment with tofacitinib, which may explain in part the relapse of disease after stopping treatment.
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Affiliation(s)
| | | | | | - Luzhou Xing
- Department of Pathology, Columbia University, New York, New York, USA
| | | | | | - Madeleine Duvic
- Department of Dermatology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - David A Norris
- Department of Dermatology, University of Colorado, Denver, Colorado, USA
| | - Vera Price
- Department of Dermatology, UCSF, San Francisco, California, USA
| | | | | | - Angela M Christiano
- Department of Dermatology and.,Department of Genetics and Development, Columbia University, New York, New York, USA
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Trüeb RM, Dias MFRG. Alopecia Areata: a Comprehensive Review of Pathogenesis and Management. Clin Rev Allergy Immunol 2018; 54:68-87. [PMID: 28717940 DOI: 10.1007/s12016-017-8620-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Alopecia areata is a common hair loss condition that is characterized by acute onset of non-scarring hair loss in usually sharply defined areas ranging from small patches to extensive or less frequently diffuse involvement. Depending on its acuity and extent, hair loss is an important cause of anxiety and disability. The current understanding is that the condition represents an organ-specific autoimmune disease of the hair follicle with a genetic background. Genome-wide association studies provide evidence for the involvement of both innate and acquired immunity in the pathogenesis, and mechanistic studies in mouse models of alopecia areata have specifically implicated an IFN-γ-driven immune response, including IFNγ, IFNγ-induced chemokines and cytotoxic CD8 T cells as the main drivers of disease pathogenesis. A meta-analysis of published trials on treatment of alopecia areata states that only few treatments have been well evaluated in randomized trials. Nevertheless, depending on patient age, affected surface area and disease duration, an empiric treatment algorithm can be designed with corticosteroids and topical immunotherapy remaining the mainstay of therapy. The obviously limited success of evidence-based therapies points to a more important complexity of hair loss. At the same time, the complexity of pathogenesis offers opportunities for the development of novel targeted therapies. New treatment opportunities based on the results of genome-wide association studies that implicate T cell and natural killer cell activation pathways are paving the way to new approaches in future clinical trials. Currently, there are ongoing studies with the CTLA4-Ig fusion protein abatacept, anti-IL15Rβ monoclonal antibodies and the Janus kinase inhibitors tofacitinib, ruxolitinib and baricitinib. Ultimately, the options available for adapting to the disease rather than treating it in an effort to cure may also be taken into consideration in selected cases of long-standing or recurrent small spot disease.
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Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb and University of Zurich, Zurich, Switzerland.
| | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Universidade Federal Fluminense, Centro de Ciências Médicas, Hospital Universitário Antonio Pedro, Niterói, Rio de Janeiro, Brazil
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Choe SJ, Lee WS. Efficacy of superficial cryotherapy on the eyebrows of patients with alopecia universalis also treated with contact immunotherapy on the scalp: a prospective, split-face comparative study. Int J Dermatol 2017; 56:184-189. [DOI: 10.1111/ijd.13533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/19/2016] [Accepted: 11/14/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Sung Jay Choe
- Department of Dermatology and Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Won-Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
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Interleukin-4 -590 T>C and interleukin-4 receptor Q551R A>G gene polymorphisms in Saudi cases with alopecia areata. J Egypt Public Health Assoc 2017; 90:20-3. [PMID: 25853541 DOI: 10.1097/01.epx.0000461326.05328.d3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Immunogenetic factors are known to play a role in the pathogenesis of alopecia areata (AA). This study aimed at investigating the association between AA with the polymorphisms of interleukin-4 (IL-4) promoter and receptor (IL-4R) genes. PATIENTS AND METHODS This work is a case-control study that was conducted on 76 AA patients from Qassim region, Saudi Arabia. Patients were compared with 93 normal healthy controls from the same locality. Genomic DNA was extracted and processed using real-time PCR amplification for characterization of IL-4 -590 T>C and IL-4R Q551R A>G gene polymorphisms. RESULTS Cases of AA showed a higher frequency of the IL-4 -590 CC homozygous genotype compared with controls (63.2 vs. 53.8%, P>0.05) with a lower frequency of the TT genotype (5.3 vs. 10.8%); yet, both were statistically nonsignificant (P>0.05). Regarding the IL-4R Q551R A>G polymorphism, cases and controls showed nearly equal frequencies of all variants, that is, with no significant difference. Although the frequency of the IL-4 C and the IL-4R A alleles was higher among cases than among controls (78.9 vs. 71.5% and 78.8 vs. 72.6%, respectively), this was also statistically nonsignificant (P>0.05). Comparing case subgroups in terms of their age of onset, sex, disease severity, consanguinity, and family history showed no statistically significant difference regarding the studied genetic variant. CONCLUSION IL-4 -590 and IL-4R Q551R gene polymorphisms are not associated with the susceptibility and the clinical pattern of AA in Saudi patients. We recommend further research studies involving the estimation of cytokines both in the serum and in the local skin lesions or in cultured skin cells to figure out whether Th1 or Th2 pathways play a specific role in the pathogenesis of AA.
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Gohary YM, Abdel Fattah DS. Detection of Tumor Necrosis Factor-alpha in Nonlesional Tissues of Alopecia Areata Patients: A Prove for a Systemic Disease. Int J Trichology 2017; 9:154-159. [PMID: 29118519 PMCID: PMC5655623 DOI: 10.4103/ijt.ijt_47_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The pathogenesis of alopecia areata (AA) remains incompletely understood. Different cytokines may play a role in AA. Tumor necrosis factor-alpha (TNF-α) has been shown to be inhibitory to hair follicle growth in in vitro studies suggesting that it may play an important role in AA. This study was conducted to assess the presence of TNF-α in lesional and nonlesional skin of AA, to review its possible role in AA, and to show whether AA is a systemic or localized disease by comparing the level of TNF-α between lesional and nonlesional skin biopsies of the patients. Materials and Methods Thirty patients with AA and thirty age- and sex-matched healthy controls were included in the study. A 4 mm punch skin biopsy was taken from lesional and nonlesional skin of every patient, as well as from the normal skin of each individual in the control group for immunohistochemical analysis of TNF-α. Results The level of TNF-α in lesional skin biopsies was significantly higher than in nonlesional skin biopsies of patients as well as controls' biopsies. Furthermore, TNF-α level in nonlesional biopsies of patients was significantly higher than the level in controls' biopsies. Conclusions We concluded that skin of AA has a high level of TNF-α (a normal inhibitor of hair follicle growth in vitro). This high level may point to the important role of TNF-α in AA. Further studies should be conducted to detect the level of TNF-α in long-standing AA and the more severe cases of AA.
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Affiliation(s)
- Yasser Mostsfa Gohary
- Department of Dermatology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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Zawar VP, Karad GM. Liquid Nitrogen Cryotherapy in Recalcitrant Alopecia Areata: A Study of 11 Patients. Int J Trichology 2016; 8:15-20. [PMID: 27127370 PMCID: PMC4830166 DOI: 10.4103/0974-7753.179403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Recalcitrant alopecia areata (AA) is not uncommon in clinical practice. In certain patients, treatment failures are known with almost every conventional therapy either singly or in combination. AIMS To study the efficacy of liquid nitrogen (LN) cryotherapy in patients with recalcitrant AA. SUBJECTS AND METHODS We present series of eleven patients of recalcitrant AA, who consulted us after getting no response to various modalities of treatment for 6 months. We treated them with LN cryotherapy every 2 weeks till significant hair regrowth or maximum five sittings (at 0, 2, 4, 6, and 8 weeks) whichever was earlier. Inclusion and exclusion criteria were applied. Each patient was counseled and a written consent was taken. Every session consisted of dual freeze and thaw cycles of 15 s each with a cryo unit spray. Two months of follow-up after last treatment was done to observe sustained re-growth of hair. STATISTICAL ANALYSIS USED The clinical response was evaluated by using regrowth scale at 4(th), 8(th), and 16(th) week. RESULTS 11 patients were recruited, one patient dropped due to inability to attend follow-ups. Remaining ten patients completed the treatment and follow-up. Out of 10 patients, five patients (50%) showed an excellent response, three (30%) had a satisfactory response, one (10%) had a fair response, and one patient (10%) had a poor response. No serious adverse effects were seen. Sustained hair regrowth was seen in 80% of patients at the 16(th) week. CONCLUSIONS LN cryotherapy may be worth trying treatment in the management of recalcitrant AA.
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Affiliation(s)
- Vijay P Zawar
- Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India
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The Frequency of Autoimmune Thyroid Disease in Alopecia Areata and Vitiligo Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:435947. [PMID: 26355833 PMCID: PMC4555361 DOI: 10.1155/2015/435947] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/04/2015] [Indexed: 11/21/2022]
Abstract
Aim. Many studies demonstrated that alopecia areata (AA) and vitiligo are commonly associated with autoimmune thyroid diseases. We aimed to investigate the frequency of thyroid dysfunctions and autoimmunity related with vitiligo and AA. Material and Methods. 200 patients, 92 AA and 108 vitiligo diagnosed, were surveyed retrospectively. The control population was in reference range and from Konya, central Anatolian region of Turkey. Thyroid function tests (free T3, free T4, and TSH) and serum thyroid autoantibody (anti-TG, anti-TPO) levels were evaluated in all patients. Results. In vitiligo patients, 9 (8.3%) had elevated anti-TG levels and 16 (14.8%) had elevated anti-TPO, and in 17 patients (15.7%) TSH levels were elevated and 3 (2.8%) patients had elevated fT4 levels and 5 (4.6%) had elevated fT3 levels. Within AA patients, 2 (2.2%) had anti-TG elevation and 13 (14.1%) had anti-TPO elevation, in 7 patients (7.6%) TSH were elevated, and in 1 patient (1.1%) fT4 were elevated and 5 (5.4%) patients had elevated fT3 levels. Conclusion. In our study, impaired thyroid functions and thyroid autoantibodies in vitiligo and AA patients were identified at lower rates than the previous studies. According to results of this study there is no need for detailed examination in alopecia areata and vitiligo patients without clinical history.
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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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Alzolibani AA, Rasheed Z, Al Robaee AA. Acquired immunogenicity of DNA after modification with malondialdehyde in patients with alopecia areata. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:312-21. [DOI: 10.3109/00365513.2014.889322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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21
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Alopecia universalis after discontinuation of pegylated interferon and ribavirin combination therapy for hepatitis C: a case report. Ann Hepatol 2014. [DOI: 10.1016/s1665-2681(19)30894-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Dwivedi N, Radic M. Citrullination of autoantigens implicates NETosis in the induction of autoimmunity. Ann Rheum Dis 2013; 73:483-91. [PMID: 24291655 DOI: 10.1136/annrheumdis-2013-203844] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tolerance blocks the expression of autoantibodies, whereas autoimmunity promotes it. How tolerance breaks and autoantibody production begins thus are crucial questions for understanding and treatment of autoimmune diseases. Evidence implicates cell death and autoantigen modifications in the initiation of autoimmune reactions. One form of neutrophil cell death called NETosis deserves attention because it requires the post-translational modification of histones and results in the extracellular release of chromatin. NETosis received its name from NET, the acronym given to Neutrophil Extracellular Trap. The extracellular chromatin incorporates histones in which arginines have been converted to citrullines by peptidylarginine deiminase IV (PAD4). The deiminated chromatin may function to capture or 'trap' bacterial pathogens, thus generating an extracellular complex of deiminated histones and bacterial cell adjuvants. The complex of bacterial antigens and deiminated chromatin may be internalised by host phagocytes during acute inflammatory conditions, as arise during bacterial infections or chronic autoinflammatory disorders. The uptake and processing of deiminated chromatin together with bacterial adjuvants by phagocytes may induce the presentation of modified histone epitopes and co-stimulation, thus yielding a powerful stimulus to break tolerance. Autoantibodies to deiminated histones are prevalent in Felty's syndrome patients and are present in systemic lupus erythematosus (SLE) and patients with rheumatoid arthritis (RA). These observations clearly implicate histone deimination as an epigenetic mark that can act as an autoantibody stimulant.
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Affiliation(s)
- Nishant Dwivedi
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Harvard Medical School, , Boston, Massachusetts, 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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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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Kalkan G, Yigit S, Karakuş N, Ateş O, Bozkurt N, Ozdemir A, Pancar GŞ. Methylenetetrahydrofolate reductase C677T mutation in patients with alopecia areata in Turkish population. Gene 2013; 530:109-12. [PMID: 23954881 DOI: 10.1016/j.gene.2013.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/01/2013] [Accepted: 08/03/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Methylene-tetrahydrofolate reductase (MTHFR) is a key enzyme regulating folate metabolism and it is thought to influence DNA methylation and nucleic acid synthesis. Mutations in the MTHFR gene have been associated with several autoimmune disorders in previous studies. Alopecia areata (AA) is considered to be a tissue-specific autoimmune disease as the hair follicle has been targeted and antibodies to their own hair follicle structures have been developed. Since there is a common shared pathway between AA and other autoimmune disorders, we aimed to investigate a possible association between the MTHFR gene C677T mutation and AA susceptibility in the Turkish population. METHODS The study included 136 patients affected by AA and 130 healthy controls. Genomic DNA was isolated and genotyped using a polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) assay for the MTHFR gene C677T mutation. RESULTS The distributions of genotype and allele frequencies of MTHFR gene C677T mutation were statistically different between AA patients and the control group (p=0.036 and p=0.011, respectively). High differences were also observed when the patients and controls were compared according to CC versus CT+TT (p=0.012). CT+TT genotypes and T allele of MTHFR gene C677T mutation were found to be a susceptibility factor for AA in the Turkish population. CONCLUSION The results suggest that MTHFR gene C677T mutation may have an effect on the risk of alopecia areata in the Turkish population. This is the first study reporting the association between the MTHFR (C677T) genotype and AA.
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Affiliation(s)
- Göknur Kalkan
- Gaziosmanpasa University, School of Medicine, Department of Dermatology, Tokat, Turkey.
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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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27
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Zhang B, Zhao Y, Cai Z, Caulloo S, McElwee KJ, Li Y, Chen X, Yu M, Yang J, Chen W, Tang X, Zhang X. Early stage alopecia areata is associated with inflammation in the upper dermis and damage to the hair follicle infundibulum. Australas J Dermatol 2013; 54:184-91. [PMID: 23808570 DOI: 10.1111/ajd.12065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/04/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Sillani Caulloo
- Department of Dermatology; The First Affiliated Hospital, Sun Yat-sen University; China
| | - Kevin J McElwee
- Department of Dermatology and Skin Science; The University of British Columbia; Vancouver; British Columbia; Canada
| | - Yang Li
- Department of Pathology; The First Affiliated Hospital, Sun Yat-sen University; China
| | - Xiaohong Chen
- Department of Dermatology; The First Affiliated Hospital, Sun Yat-sen University; China
| | - Mei Yu
- Department of Dermatology and Skin Science; The University of British Columbia; Vancouver; British Columbia; Canada
| | - Jian Yang
- Department of Dermatology; The First Affiliated Hospital, Sun Yat-sen University; China
| | - Wenna Chen
- Department of Dermatology; The First Affiliated Hospital, Sun Yat-sen University; China
| | - Xuhua Tang
- Department of Dermatology; The First Affiliated Hospital, Sun Yat-sen University; China
| | - Xingqi Zhang
- Department of Dermatology; The First Affiliated Hospital, Sun Yat-sen University; China
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Protic M, Gligorijevic V, Bojic D, Popovic B, Damjanovic S, Jojic N. Autoimmune polyglandular syndrome type 2, alopecia universalis and Crohn's disease. J Crohns Colitis 2013; 7:318-21. [PMID: 22677116 DOI: 10.1016/j.crohns.2012.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 05/11/2012] [Accepted: 05/12/2012] [Indexed: 02/08/2023]
Abstract
Autoimmune polyglandular syndromes are defined as a spectrum of association between 2 or more organ specific endocrinopaties and non-endocrine autoimmune diseases. Autoimmune polyglandular syndromes type 2 is characterized by the coexistence of adrenal failure with autoimmune thyroid disease and diabetes mellitus type 1. Inflammatory bowel diseases are rarely associated with these autoimmune disorders. Here, we report about a case of 33 years old male with known history of Crohn's colitis diagnosed in childhood. In 2003 the patient experienced sudden loss of hair, eyebrows, eyelashes, beard and body hair - alopecia universalis was diagnosed. At the age of 28, the patient was hospitalized with severe dehydration and clinical signs of ketoacidosis. Increased blood glucose (40 mmol/L), ketonuria and metabolic acidosis indicated diabetes mellitus type 1. In 2005, he had severe relapse of Crohn's disease and was treated with systemic corticosteroid. Although patient responded well to the induction therapy, fatigue, hypotension, bradycardia called for further investigations: free thyroxine - 6.99 pmol/L, thyroid-stimulating hormone >75 U/ml, anti-thyroid peroxidase antibodies >1000 U/mL, so diagnosis of Haschimoto thyroiditis was confirmed. Persistent hypotension and fatigue, recurrent hypoglycemic crises indicated a possible presence of hypo-function of adrenal glands. After complete withdrawal of corticosteroid therapy, low cortisol levels (69.4 nmol/L) and positive tetracosactide stimulation test proved adrenal cortex failure. Regardless of the intensive treatment for diabetes, hypothyroidism, adrenal insufficiency and Crohn's disease, it was extremely difficult to achieve and maintain control of all four diseases.
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Affiliation(s)
- Marijana Protic
- Department of Gastroenterology and Hepatology, University Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, Serbia.
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Kalkan G, Ateş O, Karakuş N, Sezer S. Functional polymorphisms in cell death pathway genes FAS and FAS ligand and risk of alopecia areata. Arch Dermatol Res 2013; 305:909-15. [PMID: 23591741 DOI: 10.1007/s00403-013-1354-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 03/28/2013] [Accepted: 04/03/2013] [Indexed: 01/13/2023]
Abstract
FAS and FAS ligand (FASLG) are important proapoptotic proteins that have a significant function in regulating cell growth and apoptosis and play essential roles in many human autoimmune diseases. Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease mediated by T cells to the hair follicles. The concept of an autoimmune mechanism as the basis for AA led us to investigate a possible association between the FAS and FASLG polymorphism with AA susceptibility and disease progression on AA patients in Turkish population. The study group consisted of 118 unrelated patients with AA and 118 unrelated healthy controls. We genotyped FAS-670 A/G and FASLG-124 A/G polymorphisms and assessed their association with AA risk. A statistically significant difference was observed between patients and controls according to genotype frequencies of FAS gene (p = 0.0002). GG genotype of 670 A/G polymorphism was found to be protective against AA (p = 0.000, OR 0.07, 95 % CI 0.00-0.41). It can be concluded there is a reduced risk of AA risk appeared to be associated with FAS-670 A/G. No association was observed between AA patients and controls according to genotype and allele distribution of FASLG gene 124 A/G polymorphism (p = 0.1297, p = 453, respectively). In conclusion, we provide evidence that FAS/FASLG polymorphisms may have an effect on the risk of AA in the Turkish population. These findings provide an additional support to a genetic basis for AA development.
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Affiliation(s)
- Göknur Kalkan
- Department of Dermatology, Gaziosmanpasa University School of Medicine, Tokat, 60100, Turkey,
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Single nucleotide polymorphisms in the promoter regions of Foxp3 and ICOSLG genes are associated with Alopecia Areata. Clin Exp Med 2012. [DOI: 10.1007/s10238-012-0224-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Redler S, Albert F, Brockschmidt F, Herold C, Hanneken S, Eigelshoven S, Giehl K, Kruse R, Lutz G, Wolff H, Blaumeiser B, Böhm M, Becker T, Nöthen M, Betz R. Investigation of selected cytokine genes suggests that
IL2RA
and the
TNF
/
LTA
locus are risk factors for severe alopecia areata. Br J Dermatol 2012; 167:1360-5. [DOI: 10.1111/bjd.12004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- S. Redler
- Institute of Human Genetics, University of Bonn, Sigmund‐Freud‐Str. 25, D‐53127 Bonn, Germany
| | - F. Albert
- Institute of Human Genetics, University of Bonn, Sigmund‐Freud‐Str. 25, D‐53127 Bonn, Germany
| | - F.F. Brockschmidt
- Institute of Human Genetics, University of Bonn, Sigmund‐Freud‐Str. 25, D‐53127 Bonn, Germany
- Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - C. Herold
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - S. Hanneken
- Department of Dermatology, University of Düsseldorf, Düsseldorf, Germany
| | - S. Eigelshoven
- Department of Dermatology, University of Düsseldorf, Düsseldorf, Germany
| | - K.A. Giehl
- Department of Dermatology, University of Munich, Munich, Germany
| | - R. Kruse
- Dermatological Practice, Paderborn, Germany
| | - G. Lutz
- Dermatological Practice, Hair & Nail, Wesseling, Germany
| | - H. Wolff
- Department of Dermatology, University of Munich, Munich, Germany
| | - B. Blaumeiser
- Department of Medical Genetics, University and University Hospital of Antwerp, Antwerp, Belgium
| | - M. Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - T. Becker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - M.M. Nöthen
- Institute of Human Genetics, University of Bonn, Sigmund‐Freud‐Str. 25, D‐53127 Bonn, Germany
- Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - R.C. Betz
- Institute of Human Genetics, University of Bonn, Sigmund‐Freud‐Str. 25, D‐53127 Bonn, Germany
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Rongioletti F, Christana K. Cicatricial (scarring) alopecias: an overview of pathogenesis, classification, diagnosis, and treatment. Am J Clin Dermatol 2012; 13:247-60. [PMID: 22494477 DOI: 10.2165/11596960-000000000-00000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cicatricial (scarring) alopecia forms a group of disorders in which the common final pathway is the destruction of the hair follicle unit that is replaced by fibrous tissue. Hair loss may occur as a primary event when the follicle is the main target of the disease process (primary cicatricial alopecias) or as a secondary event when the follicle act as an 'innocent bystander' in the course of a disease occurring outside of the follicular unit (secondary cicatricial alopecias). Permanent hair loss may also occur in the late phases of some nonscarring alopecias that are called 'biphasic alopecias.' Primary cicatricial alopecia accounts for 5% of all trichologic consultations at the Section of Dermatology, University of Genoa, Genoa, Italy. Considering that hair loss has a strong impact on patients' psychology and quality of life, and that cicatricial alopecias can be associated with underlying systemic implications, it is extremely important that every clinician is familiar with the diagnosis and treatment of the different types of cicatricial alopecia. An accurate clinical assessment integrated with (video) dermatoscopy and histopathologic studies permits a high standard performance of correct diagnoses. A brief review of our current knowledge of disease pathogenesis and the hypothetical disease mechanisms is presented. Some practical considerations for improving the 2001 North American Hair Research Society working classification of the primary cicatricial alopecias are suggested. The aim of treatment is to slow or stop the progression of the inflammatory waves and the scarring process at the earliest phase of involvement. Recommendations for therapy are based upon a literature review, personal experience, expected adverse effects, and some pragmatic considerations such as the cost and patient compliance.
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Rahoma S, Sandhu H, McDonagh A, Gawkrodger D, Weetman A, Kemp E. Epitopes, avidity and IgG subclasses of tyrosine hydroxylase autoantibodies in vitiligo and alopecia areata patients. Br J Dermatol 2012; 167:17-28. [DOI: 10.1111/j.1365-2133.2012.10889.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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34
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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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35
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Kemp E, Sandhu H, Weetman A, McDonagh A. Demonstration of autoantibodies against tyrosine hydroxylase in patients with alopecia areata. Br J Dermatol 2011; 165:1236-43. [DOI: 10.1111/j.1365-2133.2011.10597.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Senior PA, Koh A, Shapiro AMJ. Remission of alopecia universalis following successful clinical islet transplantation. Am J Transplant 2011; 11:2536-7. [PMID: 21951462 DOI: 10.1111/j.1600-6143.2011.03758.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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37
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Forstbauer LM, Brockschmidt FF, Moskvina V, Herold C, Redler S, Herzog A, Hillmer AM, Meesters C, Heilmann S, Albert F, Alblas M, Hanneken S, Eigelshoven S, Giehl KA, Jagielska D, Blume-Peytavi U, Garcia Bartels N, Kuhn J, Hennies HC, Goebeler M, Jung A, Peitsch WK, Kortüm AK, Moll I, Kruse R, Lutz G, Wolff H, Blaumeiser B, Böhm M, Kirov G, Becker T, Nöthen MM, Betz RC. Genome-wide pooling approach identifies SPATA5 as a new susceptibility locus for alopecia areata. Eur J Hum Genet 2011; 20:326-32. [PMID: 22027810 DOI: 10.1038/ejhg.2011.185] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Alopecia areata (AA) is a common hair loss disorder, which is thought to be a tissue-specific autoimmune disease. Previous research has identified a few AA susceptibility genes, most of which are implicated in autoimmunity. To identify new genetic variants and further elucidate the genetic basis of AA, we performed a genome-wide association study using the strategy of pooled DNA genotyping (729 cases, 656 controls). The strongest association was for variants in the HLA region, which confirms the validity of the pooling strategy. The selected top 61 single-nucleotide polymorphisms (SNPs) were analyzed in an independent replication sample (454 cases, 1364 controls). Only one SNP outside of the HLA region (rs304650) showed significant association. This SNP was then analyzed in a second independent replication sample (537 cases, 657 controls). The finding was not replicated on a significant level, but showed the same tendency. A combined analysis of the two replication samples was then performed, and the SNP rs304650 showed significant association with P=3.43 × 10(-4) (OR=1.24 (1.10-1.39)). This SNP maps to an intronic region of the SPATA5 (spermatogenesis-associated protein 5) gene on chromosome 4. The results therefore suggest the SPATA5 locus is a new susceptibility locus for AA.
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Abstract
Alopecia areata (AA) is a nonscarring, inflammatory skin disease that results in patchy hair loss. AA is unpredictable in its onset, severity, and duration making it potentially very stressful for affected individuals. Currently, the treatment options for AA are limited and the efficacy of these treatments varies from patient to patient. The exact etiology of AA is unknown. This article provides some insights into the etiopathogenesis of AA and why some people develop it. The current knowledge on the pathogenesis of AA is summarized and some of the recent hypotheses and studies on AA are presented to allow for a fuller understanding of the possible biological mechanisms of AA.
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Affiliation(s)
- Eddy Wang
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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39
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Ahn K, Choi E, Kim J, Lee J, Lee K, Bang D, Cho S. Increased retinol‐binding protein (RBP) 4 and anti‐RBP4 antibody in alopecia areata. Br J Dermatol 2011; 165:837-44. [DOI: 10.1111/j.1365-2133.2011.10482.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K.J. Ahn
- Specialization Research Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - E.A. Choi
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun‐gu, 120‐752 Seoul, Korea
| | - J. Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun‐gu, 120‐752 Seoul, Korea
| | - J.H. Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun‐gu, 120‐752 Seoul, Korea
| | - K.H. Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun‐gu, 120‐752 Seoul, Korea
| | - D. Bang
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun‐gu, 120‐752 Seoul, Korea
| | - S.B. Cho
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun‐gu, 120‐752 Seoul, Korea
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40
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Genetic variants in CTLA4 are strongly associated with alopecia areata. J Invest Dermatol 2011; 131:1169-72. [PMID: 21346773 DOI: 10.1038/jid.2010.427] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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Relapsing polychondritis following alopecia areata. Case Rep Med 2010; 2010:623158. [PMID: 20672055 PMCID: PMC2905706 DOI: 10.1155/2010/623158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 05/31/2010] [Indexed: 11/17/2022] Open
Abstract
A case of alopecia areata followed by relapsing polychondritis is presented. Similar cases from the literature are reviewed and speculation about the relationship of these diseases is offered. Although the occurrence of these diseases together could be coincidental, an association seems immunologically plausible. Thus, relapsing polychondritis might be an unusual systemic manifestation of alopecia areata.
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42
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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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43
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Ghanizadeh A. Comorbidity of psychiatric disorders in children and adolescents with alopecia areata in a child and adolescent psychiatry clinical sample. Int J Dermatol 2008; 47:1118-20. [PMID: 18986440 DOI: 10.1111/j.1365-4632.2008.03743.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmad Ghanizadeh
- Department of Psychiatry, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran.
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44
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45
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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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46
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Cruz AAV, Akaishi PMS, Vargas MA, de Paula SA. Association between thyroid autoimmune dysfunction and non-thyroid autoimmune diseases. Ophthalmic Plast Reconstr Surg 2007; 23:104-8. [PMID: 17413622 DOI: 10.1097/iop.0b013e318030b06b] [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: 12/22/2022]
Abstract
PURPOSE To assess the prevalence of the association between thyroid autoimmune dysfunction in patients with and without Graves orbitopathy and non-thyroid autoimmune diseases. METHODS Retrospective review of the medical records of 254 consecutive patients with thyroid autoimmune disease with (n = 150) and without (n = 104) orbitopathy who had been followed at the same institution by ophthalmologists and general clinicians. All medical records contained information on any systemic diseases of the patients and a detailed description of their eye examinations. The mean follow-up period was 5.25 +/- 4.67 years. RESULTS Non-thyroid autoimmune diseases were detected in 24 (9.4%) patients. Type 1 diabetes was the most prevalent non-thyroid autoimmune disease diagnosed in the patients without orbitopathy (7 patients, 6.7%). For the patients with orbitopathy, vitiligo was the most prevalent condition, affecting 6 patients (4%). Other diseases including systemic sclerosis, systemic lupus erythematosus, myasthenia gravis, Sjögren syndrome, and rheumatoid arthritis were seen in a few patients in both groups. The time intervals between the diagnoses of the orbitopathy and the non-thyroid autoimmune disease were highly variable, ranging from none (concomitance of the 2 conditions) to decades. CONCLUSIONS The present data show that several non-thyroid autoimmune diseases may be associated with thyroid autoimmune dysfunction. Patients with Graves disease without orbitopathy are likely to develop polyglandular syndrome due to the occurrence of type 1 diabetes. Patients with Graves orbitopathy should be screened for other autoimmune conditions, especially vitiligo.
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Affiliation(s)
- Antonio Augusto Velasco Cruz
- School of Medicine of Ribeirão Preto, University of São Paulo, Department of Ophthalmology, Otolaryngology, and Head-Neck Surgery, Brazil.
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47
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Choi CW, Kim BJ, Park ES, Huh CH. Alopecia areata associated with basal cell carcinoma developing within a naevus sebaceus. Br J Dermatol 2006; 155:1090-1. [PMID: 17034557 DOI: 10.1111/j.1365-2133.2006.07485.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Kemp EH, McDonagh AJG, Wengraf DA, Messenger AG, Gawkrodger DJ, Cork MJ, Tazi-Ahnini R. The non-synonymous C1858T substitution in the PTPN22 gene is associated with susceptibility to the severe forms of alopecia areata. Hum Immunol 2006; 67:535-9. [PMID: 16829308 DOI: 10.1016/j.humimm.2006.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Indexed: 11/30/2022]
Abstract
Alopecia areata is an acquired hair loss disorder resulting from an immunologically- mediated attack on hair follicles and autoimmunity may play a part in its pathogenesis. The non-synonymous C1858T substitution in the PTPN22 gene, which encodes lymphoid protein tyrosine phosphatase, has been shown to be associated with susceptibility to autoimmune disorders. In this study, the objective was to ascertain whether or not the disease-associated 1858T (W620) allele was associated with alopecia areata. For this, the allelic distribution of the PTPN22 C1858T alleles was determined in 196 English patients with alopecia areata and 507 healthy subjects in a case control study using a restriction fragment length polymorphism-polymerase chain reaction (PCR-RFLP) genotyping method. The results indicated that the frequency of the 1858T allele did not differ significantly between the alopecia areata patient group and the control cohort: of 392 alopecia areata alleles, 41 (10.5%) encoded the W620 variant compared to 86 of 1014 (8.5%) control alleles. However, in patients with severe disease, 25/168 (14.9%) alleles were 1858T and this frequency differed from that in the control group (P = 0.0127; OR, 95% CI = 1.89, 1.17 - 3.05). These results suggest that the non-synonymous C1858T substitution in the PTPN22 gene may have an influence on the severity of alopecia areata and provide further evidence for autoimmunity as an aetiological factor in this disorder.
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Affiliation(s)
- E Helen Kemp
- Division of Clinical Sciences (North), University of Sheffield, Sheffield, S5 7AU, UK
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Lueking A, Huber O, Wirths C, Schulte K, Stieler KM, Blume-Peytavi U, Kowald A, Hensel-Wiegel K, Tauber R, Lehrach H, Meyer HE, Cahill DJ. Profiling of Alopecia Areata Autoantigens Based on Protein Microarray Technology. Mol Cell Proteomics 2005; 4:1382-90. [PMID: 15939964 DOI: 10.1074/mcp.t500004-mcp200] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Protein biochips have a great potential in future parallel processing of complex samples as a research tool and in diagnostics. For the generation of protein biochips, highly automated technologies have been developed for cDNA expression library production, high throughput protein expression, large scale analysis of proteins, and protein microarray generation. Using this technology, we present here a strategy to identify potential autoantigens involved in the pathogenesis of alopecia areata, an often chronic disease leading to the rapid loss of scalp hair. Only little is known about the putative autoantigen(s) involved in this process. By combining protein microarray technology with the use of large cDNA expression libraries, we profiled the autoantibody repertoire of sera from alopecia areata patients against a human protein array consisting of 37,200 redundant, recombinant human proteins. The data sets obtained from incubations with patient sera were compared with control sera from clinically healthy persons and to background incubations with anti-human IgG antibodies. From these results, a smaller protein subset was generated and subjected to qualitative and quantitative validation on highly sensitive protein microarrays to identify novel alopecia areata-associated autoantigens. Eight autoantigens were identified by protein chip technology and were successfully confirmed by Western blot analysis. These autoantigens were arrayed on protein microarrays to generate a disease-associated protein chip. To confirm the specificity of the results obtained, sera from patients with psoriasis or hand and foot eczema as well as skin allergy were additionally examined on the disease-associated protein chip. By using alopecia areata as a model for an autoimmune disease, our investigations show that the protein microarray technology has potential for the identification and evaluation of autoantigens as well as in diagnosis such as to differentiate alopecia areata from other skin diseases.
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Affiliation(s)
- Angelika Lueking
- Medical Proteome Center, Ruhr-University Bochum, Universitätsstrasse 150, 44780 Bochum, Germany.
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Zöller M, McElwee KJ, Vitacolonna M, Hoffmann R. Apoptosis resistance in peripheral blood lymphocytes of alopecia areata patients. J Autoimmun 2004; 23:241-56. [PMID: 15501395 DOI: 10.1016/j.jaut.2004.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 07/29/2004] [Accepted: 08/03/2004] [Indexed: 01/31/2023]
Abstract
Alopecia areata (AA) is a putative, cell-mediated autoimmune disease of anagen stage hair follicles. Inter- and intra-follicular lymphocytic infiltrates are associated with alopecia that may progress from an initially patchy presentation to extensive, even universal, hair loss. We previously noted in a mouse model of AA that regulatory T cells (Treg) are absent from draining lymph nodes and that expression of CD44v7 is transiently upregulated. Both features might explain autoreactive T cell persistence. Here we explored whether similar changes are seen in AA patients' peripheral blood mononuclear cells (PBMC). There was no clear evidence for a reduction in Treg as a possible means to support sustained T cell activation. However, progressive AA patients' PBMC displayed increased resistance towards apoptosis, which was accompanied by a decrease in CD95L+ and an increase in CD44v7+ cells. Notably, an expanded population of CD4+CD25+CD154+ T cells in progressive AA patients' PBMC was apoptosis resistant and expressed CD44v7. Thus, survival of activated T cells in progressive AA patients' PBMC is apparently sustained by downregulation of CD95L and upregulation of CD44v7 which is known to be associated with anti-apoptotic gene expression.
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Affiliation(s)
- Margot Zöller
- Department of Tumor Progression and Tumor Defense, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
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