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Shi Y, Wan S, Song X. Role of neurogenic inflammation in the pathogenesis of alopecia areata. J Dermatol 2024; 51:621-631. [PMID: 38605467 DOI: 10.1111/1346-8138.17227] [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: 12/15/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
Alopecia areata refers to an autoimmune illness indicated by persistent inflammation. The key requirement for alopecia areata occurrence is the disruption of immune-privileged regions within the hair follicles. Recent research has indicated that neuropeptides play a role in the damage to hair follicles by triggering neurogenic inflammation, stimulating mast cells ambient the follicles, and promoting apoptotic processes in keratinocytes. However, the exact pathogenesis of alopecia areata requires further investigation. Recently, there has been an increasing focus on understanding the mechanisms of immune diseases resulting from the interplay between the nervous and the immune system. Neurogenic inflammation due to neuroimmune disorders of the skin system may disrupt the inflammatory microenvironment of the hair follicle, which plays a crucial part in the progression of alopecia areata.
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Affiliation(s)
- Yetan Shi
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Sheng Wan
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China
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Genedy RM, Badran FK, Tayae EM, Sabra HN. Lesson to Learn From Cellular infiltrate in Scalp Biopsy of Alopecia Areata. Am J Dermatopathol 2021; 43:e158-e164. [PMID: 33606369 DOI: 10.1097/dad.0000000000001929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a common cause of hair loss. It is mediated by T lymphocytes. Scalp biopsy findings in AA differ according to the disease phase and activity. OBJECTIVES To study the cellular infiltrate in the transverse section of scalp biopsy of AA at different disease stages and in relation to disease activity. METHODS The study was performed on 40 subjects with AA. A 4-mm punch biopsy was obtained from an AA scalp lesion. Biopsies were sectioned horizontally; 2 anatomical levels were studied (mid dermal and deep dermal levels). RESULTS Ninety-five percent of AA showed noncicatrical alopecia. A significant relation was found between the course of AA and the terminal:vellus ratio. Peribulbar lymphocytic infiltration was seen in 70% of cases. Mast cells were observed in 87.5% of cases, including fibrous tract and around the arrector pili muscles. Eosinophils were detected in the scalp biopsy of 22.5% of cases. Course and activity of AA were significantly related to the peribulbar lymphocytic cell infiltration but not to mast cells and eosinophils. CONCLUSION Although a peribulbar lymphocytic infiltrate is the classical finding of AA, it is absent in the chronic phase. Mast cells are commonly found in the scalp biopsy of AA and could explain the potential therapeutic effect of antihistamines.
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Affiliation(s)
- Rasha Mahmoud Genedy
- Department of Dermatology and Venereology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Fairouz Khalil Badran
- Department of Dermatology and Venereology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman Mohamed Tayae
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University Egypt, Alexandria, Egypt; and
| | - Heba Nasrallah Sabra
- Department of Dermatology and Venereology, Ministry of Health Hospitals, Alexandria, Egypt
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3
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Carré J, Suzuki T, Paus R. Do hair follicles operate as primitive, multifocal kidney‐like excretory (mini‐) organs? Exp Dermatol 2020; 29:357-365. [DOI: 10.1111/exd.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Jean‐Luc Carré
- Département de Biochimie et Pharmaco‐Toxicologie Hôpital de la Cavale Blanche CHRU Brest France
- EA 4685 Laboratoire des Interactions Epithelium ‐ Neurones University of Brest Brest France
| | - Takahiro Suzuki
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
- Centre for Dermatology Research University of Manchester Manchester UK
- Monasterium Laboratory Münster Germany
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4
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Broadley D, McElwee KJ. A "hair-raising" history of alopecia areata. Exp Dermatol 2020; 29:208-222. [PMID: 31960494 DOI: 10.1111/exd.14073] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/19/2019] [Accepted: 01/09/2020] [Indexed: 12/15/2022]
Abstract
A 3500-year-old papyrus from ancient Egypt provides a list of treatments for many diseases including "bite hair loss," most likely alopecia areata (AA). The treatment of AA remained largely unchanged for over 1500 years. In 30 CE, Celsus described AA presenting as scalp alopecia in spots or the "windings of a snake" and suggested treatment with caustic compounds and scarification. The first "modern" description of AA came in 1813, though treatment still largely employed caustic agents. From the mid-19th century onwards, various hypotheses of AA development were put forward including infectious microbes (1843), nerve defects (1858), physical trauma and psychological stress (1881), focal inflammation (1891), diseased teeth (1902), toxins (1912) and endocrine disorders (1913). The 1950s brought new treatment developments with the first use of corticosteroid compounds (1952), and the first suggestion that AA was an autoimmune disease (1958). Research progressively shifted towards identifying hair follicle-specific autoantibodies (1995). The potential role of lymphocytes in AA was made implicit with immunohistological studies (1980s). However, studies confirming their functional role were not published until the development of rodent models (1990s). Genetic studies, particularly genome-wide association studies, have now come to the forefront and open up a new era of AA investigation (2000s). Today, AA research is actively focused on genetics, the microbiome, dietary modulators, the role of atopy, immune cell types in AA pathogenesis, primary antigenic targets, mechanisms by which immune cells influence hair growth, and of course the development of new treatments based on these discoveries.
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Affiliation(s)
- David Broadley
- Centre for Skin Sciences, University of Bradford, Bradford, UK
| | - Kevin J McElwee
- Centre for Skin Sciences, University of Bradford, Bradford, UK.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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Juhasz M, Mesinkovska NA. Are Preferred Scalp Locations for Alopecia Areata Patches a Clue to Neuronal Etiology? Skin Appendage Disord 2019; 5:283-287. [PMID: 31559251 DOI: 10.1159/000497392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/30/2019] [Indexed: 11/19/2022] Open
Abstract
Background Alopecia areata (AA) is an autoimmune disease causing hair loss in 2% of the population. Anecdotally, hair specialists report that patches localize to the scalp periphery. Changes in sensory innervation and/or scalp vasculature may play a role in the development and localization of alopecic patches. Objective To evaluate the most common locations of initial alopecic scalp patches. Materials and Methods A retrospective chart review, with comprehensive evaluation of clinical photographs, was conducted from July 2016 to June 2018 to include AA patients (n = 112). Clinical data was collected on gender, age, race, time until presentation at the clinic, and areas of hair loss on initial presentation. Results The most common areas of initial AA patches in both females and males were the occiput (49 vs. 48.5%), parietal (46.9 vs. 21.2%), vertex (26.5 vs. 18.2%), and frontal (24.5 vs. 18.2%) regions; 26.8% of patients present with either alopecia totalis or universalis. Limitations This is a single-center study with underrepresentation of minority races. Conclusion AA patches most commonly present on the occiput of the scalp in both female and male patients. Cervical spine nerves C3 and C2 supply sensory innervation and the occipital artery supplies blood to this area.
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Affiliation(s)
- Margit Juhasz
- Department of Dermatology, University of California, Irvine, Irvine, California, USA
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6
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Rajabi F, Drake LA, Senna MM, Rezaei N. Alopecia areata: a review of disease pathogenesis. Br J Dermatol 2018; 179:1033-1048. [PMID: 29791718 DOI: 10.1111/bjd.16808] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alopecia areata is a disorder that results in nonscarring hair loss. The psychological impact can be significant, leading to feelings of depression and social isolation. Objectives In this article, we seek to review the pathophysiological mechanisms proposed in recent years in a narrative fashion. METHODS We searched MEDLINE and Scopus for articles related to alopecia areata, with a particular emphasis on its pathogenesis. RESULTS The main theory of alopecia areata pathogenesis is that it is an autoimmune phenomenon resulting from a disruption in hair follicle immune privilege. What causes this breakdown is an issue of debate. Some believe that a stressed hair follicle environment triggers antigen presentation, while others blame a dysregulation in the central immune system entangling the follicles. Evidence for the latter theory is provided by animal studies, as well investigations around the AIRE gene. Different immune-cell lines including plasmacytoid dendritic cells, natural killer cells and T cells, along with key molecules such as interferon-γ, interleukin-15, MICA and NKG2D, have been identified as contributing to the autoimmune process. CONCLUSIONS Alopecia areata remains incurable, although it has been studied for years. Available treatment options at best are beneficial for milder cases, and the rate of relapse is high. Understanding the exact mechanisms of hair loss in alopecia areata is therefore of utmost importance to help identify potential therapeutic targets.
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Affiliation(s)
- F Rajabi
- Department of Dermatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - L A Drake
- Massachusetts General Hospital, Harvard Medical School, MA, U.S.A
| | - M M Senna
- Massachusetts General Hospital, Harvard Medical School, MA, U.S.A
| | - N Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Sheffield, U.K
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Woo YR, Hwang S, Jeong SW, Cho DH, Park HJ. Erythroid Differentiation Regulator 1 as a Novel Biomarker for Hair Loss Disorders. Int J Mol Sci 2017; 18:ijms18020316. [PMID: 28165377 PMCID: PMC5343852 DOI: 10.3390/ijms18020316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/16/2022] Open
Abstract
Erythroid differentiation regulator 1 (Erdr1) is known to be involved in the inflammatory process via regulating the immune system in many cutaneous disorders, such as psoriasis and rosacea. However, the role of Erdr1 in various hair loss disorders remains unclear. The aim of this study was to investigate the putative role of Erdr1 in alopecias. Skin samples from 21 patients with hair loss disorders and five control subjects were retrieved, in order to assess their expression levels of Erdr1. Results revealed that expression of Erdr1 was significantly downregulated in the epidermis and hair follicles of patients with hair loss disorders, when compared to that in the control group. In particular, the expression of Erdr1 was significantly decreased in patients with alopecia areata. We propose that Erdr1 downregulation might be involved in the pathogenesis of hair loss, and could be considered as a novel biomarker for hair loss disorders.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Sewon Hwang
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Seo Won Jeong
- Institute of Clinical Medical Research, Yeouido St. Mary's Hostpital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Dae Ho Cho
- Department of Life Science, Sookmyung Women's University, Seoul 04310, Korea.
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
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Farah RS, Farah RS, Junqueira Bertin AC, Guo H, Ericson ME, Hordinsky MK. Increased cutaneous stimulation is required for C-fiber sensory perception in alopecia areata: A double-blind study. J Am Acad Dermatol 2016; 75:1265-1267. [DOI: 10.1016/j.jaad.2016.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022]
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9
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Bertolini M, Pretzlaff M, Sulk M, Bähr M, Gherardini J, Uchida Y, Reibelt M, Kinori M, Rossi A, Bíró T, Paus R. Vasoactive intestinal peptide, whose receptor-mediated signalling may be defective in alopecia areata, provides protection from hair follicle immune privilege collapse. Br J Dermatol 2016; 175:531-41. [PMID: 27059672 DOI: 10.1111/bjd.14645] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disorder whose pathogenesis involves the collapse of the relative immune privilege (IP) of the hair follicle (HF). Given that vasoactive intestinal peptide (VIP) is an immunoinhibitory neuropeptide released by perifollicular sensory nerve fibres, which play a role in IP maintenance, it may modulate human HF-IP and thus be therapeutically relevant for AA. OBJECTIVES To answer the following questions: Do human HFs express VIP receptors, and does their stimulation protect from or restore experimentally induced HF-IP collapse? Is VIP signalling defective in AA HFs? METHODS Firstly, VIP and VIP receptor (VPAC1, VPAC2) expression in human scalp HFs and AA skin was assessed. In HF organ culture, we then explored whether VIP treatment can restore and/or protect from interferon-γ-induced HF-IP collapse, assessing the expression of the key IP markers by quantitative (immuno-)histomorphometry. RESULTS Here we provide the first evidence that VIP receptors are expressed in the epithelium of healthy human HFs at the gene and protein level. Furthermore, VIP receptor protein expression, but not VIP(+) nerve fibres, is significantly downregulated in lesional hair bulbs of patients with AA, suggesting defects in VIP receptor-mediated signalling. Moreover, we show that VIP protects the HF from experimentally induced IP collapse in vitro, but does not fully restore it once collapsed. CONCLUSIONS These pilot data suggest that insufficient VIP receptor-mediated signalling may contribute to impairing HF-IP in patients with AA, and that VIP is a promising candidate 'HF-IP guardian' that may be therapeutically exploited to inhibit the progression of AA lesions.
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Affiliation(s)
- M Bertolini
- Department of Dermatology, University of Münster, Münster, Germany.
| | - M Pretzlaff
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - M Sulk
- Department of Dermatology, University of Münster, Münster, Germany
| | - M Bähr
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - J Gherardini
- Department of Dermatology, University of Münster, Münster, Germany
| | - Y Uchida
- Department of Dermatology, University of Münster, Münster, Germany.,Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - M Reibelt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - M Kinori
- Department of Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel
| | - A Rossi
- Department of Internal Medicine and Medical Specialties, University 'La Sapienza', Rome, Italy
| | - T Bíró
- DE-MTA 'Lendület' Cellular Physiology Research Group, Departments of Immunology and Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Paus
- Department of Dermatology, University of Münster, Münster, Germany.,Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester, U.K
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10
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Gupta AK, Carviel JL, Abramovits W. Efficacy of tofacitinib in treatment of alopecia universalis in two patients. J Eur Acad Dermatol Venereol 2016; 30:1373-8. [PMID: 27306107 DOI: 10.1111/jdv.13598] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autoimmune-triggered non-scarring hair loss is a feature of alopecia areata (AA). Initially patchy and often self-limited, severe hair loss forms include the complete loss of scalp hair or alopecia totalis (AT) and complete loss of all hair or alopecia universalis (AU). For AT and AU a reliable treatment has remained elusive. The targeted kinase inhibitor tofacitinib, in current use for treatment of other immune diseases, has been hypothesized as a viable option for AA, AT and AU therapy and a few case reports support this. OBJECTIVE Our study aims to provide evidence for the effectiveness of tofacitinib in the treatment of AU. METHODS Two patients diagnosed with long-term AU were prescribed tofacitinib citrate at a dosage of 5 mg twice daily and observed for eight months. RESULTS In the first patient, beard growth was significant by 3 months of treatment. By 6 months of treatment, hair growth was apparent throughout the entire body. By 8 months of treatment, scalp hair continued to grow longer and thicker. In addition, eyelashes and eyebrows were established. In the second patient, a noticeable increase in scalp hair was present just 1 month into treatment. By 4 months into treatment, significant scalp regrowth was observed as well as eyelash, eyebrow and beard regrowth. Axillary hair regrowth and isolated leg hair was noted by 8 months. CONCLUSION In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side-effects. We recommend that further study be required to establish safety and confirm efficacy.
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Affiliation(s)
- A K Gupta
- Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,Mediprobe Research Inc., London, Ontario, Canada
| | - J L Carviel
- Mediprobe Research Inc., London, Ontario, Canada
| | - W Abramovits
- Department of Medicine, Baylor University Medical Center, Dallas, TX, USA.,Departments of Dermatology and Family Practice, University of Texas Southwestern Medical School, Dallas, TX, USA.,Dermatology Treatment and Research Center, Dallas, TX, USA
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12
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The role of selectins in alopecia areata. Postepy Dermatol Alergol 2015; 32:27-32. [PMID: 25821424 PMCID: PMC4360002 DOI: 10.5114/pdia.2014.40946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/03/2013] [Accepted: 11/07/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction One of the main histopathological features of alopecia areata (AA) is a lymphocytic infiltration that surrounds hair follicles. Soluble forms of E, L, P-selectins are known indicators of ongoing inflammation. There are no studies regarding the assessment of their contribution in AA. Aim To assess serum concentrations of selectins (E-selectin, L-selectin and P-selectin) in patients with AA in relation to selected clinical parameters, including disease severity and activity. Material and methods Sixty-four patients with AA were involved in the study. The diagnosis was based on physical examination and photodermoscopy. The control group consisted of 40 healthy subjects. The serum concentrations of soluble E-selectin, L-selectin and P-selectin were detected with ELISA method. Results Statistically significantly higher levels of E, P, L-selectins were found in AA patients as compared with the healthy group. Serum concentrations of soluble forms of E- and L-selectins correlated with the severity of the disease, while E-selectin with activity of AA. Conclusions This study shows that selectins may play an important role in the pathogenesis of AA and may be a target of future therapies in this disease.
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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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14
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Liezmann C, Stock D, Peters EMJ. Stress induced neuroendocrine-immune plasticity: A role for the spleen in peripheral inflammatory disease and inflammaging? DERMATO-ENDOCRINOLOGY 2013; 4:271-9. [PMID: 23467333 PMCID: PMC3583888 DOI: 10.4161/derm.22023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Research over the past decade has revealed close interaction between the nervous and immune systems in regulation of peripheral inflammation linking psychosocial stress with chronic somatic disease and aging. Moreover emerging data suggests that chronic inflammations lead to a pro-inflammatory status underlying premature aging called inflammaging. In this context, the spleen can be seen as a switch board monitoring peripherally derived neuroendocrine-immune mediators in the blood and keeping up a close communication with the central stress response via its mainly sympathetic innervation. The effect aims at balanced and well-timed stress axis activation and immune adaptation in acute peripheral inflammatory events. Constant adjustment to the needs generated by environmental and endogenous challenges is provided by neuroendocrine-immune plasticity. However, maladaptive plasticity induced e.g., by chronic stress-axis activation and excessive non-neuronal derived neuroendocrine mediators may be at the heart of the observed stress sensitivity promote inflammaging under chronic inflammatory conditions. We here review the role of neurotransmitters, neuropeptides and neurotrophins as stress mediators modulating the immune response in the spleen and their potential role in inflammaging.
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Affiliation(s)
- Christiane Liezmann
- Department of Psychosomatic Medicine; Psychoneuroimmunology Laboratory; Justus-Liebig University; Giessen, Germany
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15
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Morisaki N, Ohuchi A, Moriwaki S. The role of neprilysin in regulating the hair cycle. PLoS One 2013; 8:e55947. [PMID: 23418484 PMCID: PMC3572137 DOI: 10.1371/journal.pone.0055947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/03/2013] [Indexed: 11/18/2022] Open
Abstract
In most mammals, each hair follicle undergoes a cyclic process of growing, regressing and resting phases (anagen, catagen, telogen, respectively) called the hair cycle. Various biological factors have been reported to regulate or to synchronize with the hair cycle. Some factors involved in the extracellular matrix, which is a major component of skin tissue, are also thought to regulate the hair cycle. We have focused on an enzyme that degrades elastin, which is associated with skin elasticity. Since our previous study identified skin fibroblast elastase as neprilysin (NEP), we examined the fluctuation of NEP enzyme activity and its expression during the synchronized hair cycle of rats. NEP activity in the skin was elevated at early anagen, and decreased during catagen to telogen. The expression of NEP mRNA and protein levels was modulated similarly. Immunostaining showed changes in NEP localization throughout the hair cycle, from the follicular epithelium during early anagen to the dermal papilla during catagen. To determine whether NEP plays an important role in regulating the hair cycle, we used a specific inhibitor of NEP (NPLT). NPLT was applied topically daily to the dorsal skin of C3H mice, which had been depilated in advance. Mice treated with NPLT had significantly suppressed hair growth. These data suggest that NEP plays an important role in regulating the hair cycle by its increased expression and activity in the follicular epithelium during early anagen.
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Affiliation(s)
- Naoko Morisaki
- Biological Science Laboratories, Kao Corporation, Haga-gun, Tochigi, Japan.
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Kinori M, Bertolini M, Funk W, Samuelov L, Meyer KC, Emelianov VU, Hasse S, Paus R. Calcitonin gene-related peptide (CGRP) may award relative protection from interferon-γ-induced collapse of human hair follicle immune privilege. Exp Dermatol 2012; 21:223-6. [DOI: 10.1111/j.1600-0625.2011.01432.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Abstract
Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between mind and skin. It is divided into three categories according to the relationship between skin diseases and mental disorders. This article reviews different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/depression and those caused by psychiatric disorders are discussed. This review intends to present the relationship between the 'skin' and the 'mind' specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted. A multidisciplinary approach for treatment from both dermatologic and psychiatric viewpoints are suggested.
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Affiliation(s)
- K H Basavaraj
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS University, Mysore - 570 015, Karnataka, India
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Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol 2010; 62:177-88, quiz 189-90. [PMID: 20115945 DOI: 10.1016/j.jaad.2009.10.032] [Citation(s) in RCA: 285] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 09/08/2009] [Accepted: 10/12/2009] [Indexed: 12/15/2022]
Abstract
UNLABELLED Alopecia areata (AA) is an autoimmune disease that presents as nonscarring hair loss, although the exact pathogenesis of the disease remains to be clarified. Disease prevalence rates from 0.1% to 0.2% have been estimated for the United States. AA can affect any hair-bearing area. It often presents as well demarcated patches of nonscarring alopecia on skin of overtly normal appearance. Recently, newer clinical variants have been described. The presence of AA is associated with a higher frequency of other autoimmune diseases. Controversially, there may also be increased psychiatric morbidity in patients with AA. Although some AA features are known poor prognostic signs, the course of the disease is unpredictable and the response to treatment can be variable. Part one of this two-part series on AA describes the clinical presentation and the associated histopathologic picture. It also proposes a hypothesis for AA development based on the most recent knowledge of disease pathogenesis. LEARNING OBJECTIVES After completing this learning activity, participants should be familiar with the most recent advances in AA pathogenesis, recognize the rare and recently described variants of AA, and be able to distinguish between different histopathologic stages of AA.
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INUI S, NAKAJIMA T, TODA N, ITAMI S. Fexofenadine hydrochloride enhances the efficacy of contact immunotherapy for extensive alopecia areata: Retrospective analysis of 121 cases. J Dermatol 2009; 36:323-7. [DOI: 10.1111/j.1346-8138.2009.00647.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
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Granstein RD, Luger TA. The Role of Neuropeptide Endopeptidases in Cutaneous Immunity. NEUROIMMUNOLOGY OF THE SKIN 2009. [PMCID: PMC7120023 DOI: 10.1007/978-3-540-35989-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Proteolytic processing and degradation plays an important role in modulating the generation and bioactivity of neuroendocrine peptide mediators, a class of key molecules in cutaneous biology. Accordingly, the cellular localization and expression, and the molecular biology and structural properties of selected intracellular prohormone convertases and ectopically expressed zinc-binding metalloendoproteases are discussed. A special reference will be made to the physiologic and pathophysiologic significance of these endopeptidases in cutaneous immunobiology. Because of the number of pathologically relevant changes in inflammation and tumor progression that can be directly attributed to neprilysin and angiotensin-converting enzyme, a particular focus will be on the role of these enzymes in modulating innate and adaptive immune responses in the skin.
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Affiliation(s)
- Richard D. Granstein
- Weill Cornell Medical College Department of Dermatology, Cornell University, 1300 York Ave., 10021 New York, NY USA
| | - Thomas A. Luger
- Medizinische Einrichtungen Klinik und Poliklinik für, Universitätsklinikum Münster, Von-Esmarch-Str. 56, 48149 Münster, Germany
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Development of alopecia areata is associated with higher central and peripheral hypothalamic-pituitary-adrenal tone in the skin graft induced C3H/HeJ mouse model. J Invest Dermatol 2008; 129:1527-38. [PMID: 19020552 DOI: 10.1038/jid.2008.371] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The relationship of the stress response to the pathogenesis of alopecia areata (AA) was investigated by subjecting normal and skin graft-induced, AA-affected C3H/HeJ mice to light ether anesthesia or restraint stress. Plasma corticosterone (CORT), adrenocorticotropic hormone (ACTH), and estradiol (E2) levels were determined by RIA, whereas gene expression in brains, lymphoid organs, and skin was measured by quantitative RT-PCR for corticotropin-releasing hormone (Crh), arginine vasopressin (Avp), proopiomelanocortin (Pomc), glucocorticoid receptor (Nr3c1), mineralocorticoid receptor (Nr3c2), corticotropin-releasing hormone receptor types 1 and 2 (Crhr1, Crhr2), interleukin-12 (Il12), tumor necrosis factor-alpha (Tnf alpha), and estrogen receptors type-1 (Esr1) and type-2 (Esr2). AA mice had a marked increase in hypothalamic-pituitary-adrenal (HPA) tone and activity centrally, and peripherally in the skin and lymph nodes. There was also altered interaction between the adrenal and gonadal axes compared with that in normal mice. Stress further exacerbated changes in AA mouse HPA activity both centrally and peripherally. AA mice had significantly blunted CORT and ACTH responses to acute ether stress (physiological stressor) and a deficit in habituation to repeated restraint stress (psychological stressor). The positive correlation of HPA hormone levels with skin Th1 cytokines suggests that altered HPA activity may occur as a consequence of the immune response associated with AA.
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Lee WJ, Jung HD, Lee HJ, Kim BS, Lee SJ, Kim DW. Influence of substance-P on cultured sebocytes. Arch Dermatol Res 2008; 300:311-6. [PMID: 18427822 DOI: 10.1007/s00403-008-0854-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 03/05/2008] [Accepted: 04/07/2008] [Indexed: 12/30/2022]
Abstract
Acne is a complex, chronic and common skin disorder of pilosebaceous units. Although it is known that exacerbation of acne results from emotional stress, the nature of the association between stress and acne remains unclear. This is due in part to the lack of substantial evidence regarding the participation of cutaneous neurogenic factors in the pathogenesis of acne. Culture of sebocytes provides a new insight into the participation of neuropeptides, notably substance P (SP), in the pathophysiology of acne. To examine the possible involvement of neurogenic factors in the pathogenesis of acne, we used immunohistochemistry and RT-PCR to compare the expression of interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), peroxisome proliferators activated receptors-gamma (PPAR-gamma) on the cultured sebocytes stimulated by SP. IL-1 is primarily proinflammatory cytokines to stimulate the expression of genes associated with inflammation. IL-6 is a pleiotropic cytokine with a wide range of biological activities and regulates inflammation. TNF-alpha is a pleiotropic pro-inflammatory cytokine that exerts multiple biologic effects. PPAR-gamma is a nuclear hormone receptor and plays a unique role in stimulating sebocyte lipogenesis. More numerous immunoreactivity to IL-1, IL-6, TNF-alpha and PPAR-gamma and increased RNA amplification for IL-1, IL-6, TNF-alpha and PPAR-gamma were observed after addition of SP compared with the control. This study reveals that SP is involved in the pathogenesis of acne.
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Affiliation(s)
- Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Jung-gu, Daegu, Republic of Korea.
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Scholzen TE, König S, Fastrich M, Böhm M, Luger TA. Terminating the stress: peripheral peptidolysis of proopiomelanocortin-derived regulatory hormones by the dermal microvascular endothelial cell extracellular peptidases neprilysin and angiotensin-converting enzyme. Endocrinology 2007; 148:2793-805. [PMID: 17363457 DOI: 10.1210/en.2006-1765] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The skin including the microvascular endothelium is an established peripheral source and target of the immunomodulatory proopiomelanocortin (POMC) peptides ACTH and alpha-MSH. Whereas intracellular POMC peptide generation is well characterized, less is known on their extracellular processing in peripheral tissues by the neuropeptide-specific zinc metalloproteases neprilysin (NEP) and angiotensin-converting enzyme (ACE). This may locally control POMC peptide bioavailability and activation of ACTH/alpha-MSH-specific melanocortin receptors (MCs). In a cell-free system, endothelial cell (EC) membranes prepared from ACE(high)/NEP(low)-expressing primary human dermal microvascular ECs and the ACE(low)/NEP(high) expressing EC line HMEC-1 degraded ACTH(1-39) over time, resulting in temporary increased alpha-MSH immunoreactivity. Matrix-assisted laser desorption/ionization time-of-flight mass spectroscopy peptide mapping and electrospray ionization-mass spectroscopy sequencing identified several stable fragments generated from ACTH(1-39), ACTH(1-24), and alpha-MSH by EC membranes or recombinant NEP and ACE. Whereas some fragments could be assigned to a cell-specific NEP or ACE activity, other degradation products require additional enzyme activity. Pharmacological NEP inhibition enhanced the ACTH and alpha-MSH-mediated activation of EC ectopically expressing MC(1). Likewise, selected peptides such as alpha-MSH(2-12) generated from ACTH(1-39) and alpha-MSH by recombinant NEP displayed equipotent MC(1)-activating properties in vitro and antiinflammatory activity in murine allergic contact dermatitis in vivo as compared with the parental peptides. Thus, NEP and ACE significantly contribute to the EC processing of stress hormones (ACTH) and antiinflammatory peptides (alpha-MSH), which modulates MC(1) activation but does not completely inactivate the peptide ligand. Because NEP and ACE are regulated by inflammatory mediators and UV light, this may be important for ACTH/MSH-modulated skin inflammation.
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Affiliation(s)
- Thomas E Scholzen
- Ludwig Boltzmann Institute for Cell Biology and Immunobiology of the Skin, Department of Dermatology, University of Münster, Von-Esmarch-Strasse 58, 48149 Münster, Germany.
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Siebenhaar F, Sharov AA, Peters EMJ, Sharova TY, Syska W, Mardaryev AN, Freyschmidt-Paul P, Sundberg JP, Maurer M, Botchkarev VA. Substance P as an Immunomodulatory Neuropeptide in a Mouse Model for Autoimmune Hair Loss (Alopecia Areata). J Invest Dermatol 2007; 127:1489-97. [PMID: 17273166 DOI: 10.1038/sj.jid.5700704] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alopecia areata (AA) is an autoimmune disorder of the hair follicle characterized by inflammatory cell infiltrates around actively growing (anagen) hair follicles. Substance P (SP) plays a critical role in the cutaneous neuroimmune network and influences immune cell functions through the neurokinin-1 receptor (NK-1R). To better understand the role of SP as an immunomodulatory neuropeptide in AA, we studied its expression and effects on immune cells in a C3H/HeJ mouse model for AA. During early stages of AA development, the number of SP-immunoreactive nerve fibers in skin is increased, compared to non-affected mice. However, during advanced stages of AA, the number of SP-immunoreactive nerves and SP protein levels in skin are decreased, whereas the expression of the SP-degrading enzyme neutral endopeptidase (NEP) is increased, compared to control skin. In AA, NK-1R is expressed on CD8+ lymphocytes and macrophages accumulating around affected hair follicles. Additional SP supply to the skin of AA-affected mice leads to a significant increase of mast cell degranulation and to accelerated hair follicle regression (catagen), accompanied by an increase of CD8+ cells-expressing granzyme B. These data suggest that SP, NEP, and NK-1R serve as important regulators in the molecular signaling network modulating inflammatory response in autoimmune hair loss.
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Affiliation(s)
- Frank Siebenhaar
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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Jafferany M. Psychodermatology: a guide to understanding common psychocutaneous disorders. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2007; 9:203-13. [PMID: 17632653 PMCID: PMC1911167 DOI: 10.4088/pcc.v09n0306] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 10/10/2006] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This review focuses on classification and description of and current treatment recommendations for psychocutaneous disorders. Medication side effects of both psychotropic and dermatologic drugs are also considered. DATA SOURCES A search of the literature from 1951 to 2004 was performed using the MEDLINE search engine. English-language articles were identified using the following search terms: skin and psyche, psychiatry and dermatology, mind and skin, psychocutaneous, and stress and skin. DATA SYNTHESIS The psychotropic agents most frequently used in patients with psychocutaneous disorders are those that target anxiety, depression, and psychosis. Psychiatric side effects of dermatologic drugs can be significant but can occur less frequently than the cutaneous side effects of psychiatric medications. In a majority of patients presenting to dermatologists, effective management of skin conditions requires consideration of associated psychosocial factors. For some dermatologic conditions, there are specific demographic and personality features that commonly associate with disease onset or exacerbation. CONCLUSIONS More than just a cosmetic disfigurement, dermatologic disorders are associated with a variety of psychopathologic problems that can affect the patient, his or her family, and society together. Increased understanding of biopsychosocial approaches and liaison among primary care physicians, psychiatrists, and dermatologists could be very useful and highly beneficial.
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Affiliation(s)
- Mohammad Jafferany
- Division of Child and Adolescent Psychiatry, University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, WA, USA.
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Kim HS, Cho DH, Kim HJ, Lee JY, Cho BK, Park HJ. Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone and alpha-melanocyte-stimulating hormone in alopecia areata. Exp Dermatol 2006; 15:515-22. [PMID: 16761960 DOI: 10.1111/j.1600-0625.2006.00443.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Psychological factors are believed to play a role in the pathogenesis of alopecia areata (AA), a frequently encountered hair disorder. In our study, statistically significant elevation of psychological stress was felt by AA patients prior hair loss compared with control, which was strongly believed contributory to hair loss (t-test, P < 0.01). The corticotropin-releasing hormone (CRH) and proopiomelanocortin (POMC) mRNA have been identified in the basal layer of the epidermis and pilosebaceous units of the normal scalp. And with the recent discovery of melanocytes and dermal fibroblasts capable of corticosterone production, the presence of a local stress response system resembling the hypothalamic-pituitary-adrenal (HPA) axis has been suggested. The local stress response system is involved in regulation of the normal hair cycle, but its precise role in AA is unknown. The influence of a local HPA axis or rather, CRH-POMC axis in AA was investigated by analysing immunohistochemically the expression levels of CRH and POMC peptides, including the adrenocorticotropic hormone (ACTH) and alpha-melanocyte-stimulating hormone (alpha-MSH), in a number of AA lesions and normal scalp (as control). The epidermis and pilosebaceous units of normal scalp stained weakly with CRH, ACTH and alpha-MSH, whereas those from the affected sites of the AA group showed intense expression of the peptides (chi-square test, P < 0.01). The meaning of this enhanced expression and their role in the pathogenesis of AA should be further evaluated in future.
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Affiliation(s)
- Hei Sung Kim
- Department of Dermatology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim HS, Cho DH, Kim HJ, Lee JY, Cho BK, Park HJ. Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone and α-melanocyte-stimulating hormone in alopecia areata. Exp Dermatol 2006. [DOI: 10.1111/j.1600-0625.2006.00001.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim HS, Cho DH, Kim HJ, Lee JY, Cho BK, Park HJ. Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone and α-melanocyte-stimulating hormone in alopecia areata. Exp Dermatol 2006. [DOI: 10.1111/j.1600-0625.2006.00004.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim HS, Cho DH, Kim HJ, Lee JY, Cho BK, Park HJ. Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone andα-melanocyte-stimulating hormone in alopecia areata. Exp Dermatol 2006. [DOI: 10.1111/j.1600-0625.2006.00003.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim HS, Cho DH, Kim HJ, Lee JY, Cho BK, Park HJ. Immunoreactivity of corticotropin-releasing hormone, adrenocorticotropic hormone and α-melanocyte-stimulating hormone in alopecia areata. Exp Dermatol 2006. [DOI: 10.1111/j.1600-0625.2006.00002.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yada K, Kashima K, Daa T, Kitano S, Fujiwara S, Yokoyama S. Expression of CD10 in Basal Cell Carcinoma. Am J Dermatopathol 2004; 26:463-71. [PMID: 15618927 DOI: 10.1097/00000372-200412000-00004] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We investigated the expression of CD10 by an immunohistochemical method in 51 basal cell carcinomas (BCCs), eight pilomatricomas, five trichoblastomas, two trichofolliculomas, three sebaceomas, five sebaceous carcinomas, ten syringomas, two spiradenomas, ten poromas, four porocarcinomas, one eccrine duct carcinoma (not otherwise specified, NOS), six mixed tumors of apocrine origin, and nine squamous cell carcinomas (SCCs). We detected strong expression of CD10 in tumor cells of BCC (86%), and found that the smaller the number of positive tumor cells, the larger the number of positive stromal cells, in particular in sclerosing BCCs. Spearman's rank correlation test revealed a significant negative correlation in BCCs between the expression of CD10 in tumor cells and that in stromal cells (P = 0.001). In all pilomatricomas (100%) and in four trichoblastomas (80%), strong expression was also detected in tumor cells. There was no detectable expression in trichofolliculomas. One sebaceoma (33%) and two sebaceous carcinomas (40%) expressed CD10 in a similar fashion to BCCs. All tumors of eccrine gland origin, including syringoma, spiradenoma, poroma, porocarcinoma, and eccrine duct carcinoma (NOS), did not express CD10. Five mixed tumors (83%) were immunopositive. In SCC, CD10 was overexpressed only in the stromal cells. These findings support the hypothesis that BCC is derived from the folliculo-sebaceous apocrine unit, especially having the same origin as trichoblastoma and pilomatricoma. CD10 might be an indicator of tumor invasiveness if it is expressed in stromal cells, while it might be a marker of follicular differentiation if it is expressed in the actual tumor cells of cutaneous epithelial neoplasms.
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Affiliation(s)
- Kazuhiro Yada
- Department of Pathology, Faculty of Medicine, Oita University, Oita 879-5593, Japan
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Scholzen TE, Luger TA. Neutral endopeptidase and angiotensin-converting enzyme - key enzymes terminating the action of neuroendocrine mediators. Exp Dermatol 2004; 13 Suppl 4:22-6. [PMID: 15507108 DOI: 10.1111/j.1600-0625.2004.00260.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zinc-metalloproteases, such as neutral endopeptidase (NEP) and angiotensin-converting enzyme (ACE), effectively control the bioavailability of peptide mediators released from sensory nerves, immune and skin cells during the cutaneous response to endogenous or exogenous noxious stimuli. Functional inactivation of NEP or ACE by transient inhibition or permanent genomic deletion results in a relative abundance of substance P (SP) and bradykinin (BK); this augments murine allergic contact dermatitis (ACD) by affecting ACD sensitization and elicitation, which involves neurokinin 1 receptors (NK1), BK receptors (B2) and an intact cutaneous sensory nervous system. Present evidence suggests that increased SP via NK(1) is capable of boosting important functions of SP- and NK1-expressing dendritic cells (DCs) and T cells (TCs) in an auto- or paracrine manner, which promotes ACD antigen sensitization. Moreover, skin inflammation or wounding in vivo, as well as treatment of epidermal and dermal cells by UV light and inflammatory mediators in vitro, regulates NEP and ACE expression and activity. Likewise, NEP and ACE are capable of processing neuroendocrine hormones, such as adrenocorticotropin and alpha-melanocyte-stimulating hormone. Thus, present data indicate that ACE and NEP, via proteolytic cleavage of peptide mediators and growth factors, represent important control factors for the inflammatory response in skin disorders such as psoriasis or allergic inflammation, but may also be capable of affecting pigmentation, cell survival, wound healing and tissue regeneration.
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Affiliation(s)
- Thomas E Scholzen
- Ludwig-Boltzmann Institute of Cell Biology and Immunobiology of the Skin, Department of Dermatology, University of Münster, Münster, Germany.
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Meyronet D, Jaber K, Gentil-Perret A, Cambazard F, Misery L. Decreased CGRP staining in alopecia areata. Br J Dermatol 2003; 149:422-4. [PMID: 12932259 DOI: 10.1046/j.1365-2133.2003.05425.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Toyoda M, Nakamura M, Makino T, Kagoura M, Morohashi M. Sebaceous glands in acne patients express high levels of neutral endopeptidase. Exp Dermatol 2002; 11:241-7. [PMID: 12102663 DOI: 10.1034/j.1600-0625.2002.110307.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acne is a complex, chronic and common skin disorder of pilosebaceous units. Although it is known that exacerbation of acne results from emotional stress, the nature of the association between stress and acne remains unclear. This is due in part to the lack of substantial evidence regarding the participation of cutaneous neurogenic factors in the pathogenesis of acne. To examine the possible involvement of neurogenic factors in the etiology of acne, we used immunohistochemistry to compare the distribution of SP-containing nerve fibers around sebaceous glands and the expression of neutral endopeptidase in sebaceous acini of the facial skin of acne patients and of healthy subjects. More numerous substance P immunoreactive nerve fibers in close apposition to the sebaceous glands and an increase in expression of neutral endopeptidase in sebaceous acini were observed in acne patients compared with the controls. Immunoelectron microscopy revealed that the subcellular localization of neutral endopeptidase was restricted to the Golgi apparatus and the endoplasmic reticulum within sebaceous germinative cells. In addition, in vitro experiments using an organ culture system demonstrated that substance P induced expression of neutral endopeptidase in sebaceous glands in a dose dependent manner. This study reveals that substance P and its degrading enzymes are involved in the pathogenesis of acne, which in turn might partially explain the pathologic significance of neurogenic and psychogenic aspects in the disease process.
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Affiliation(s)
- M Toyoda
- Department of Dermatology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan.
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Affiliation(s)
- V A Randall
- Department of Biomedical Sciences, University of Bradford, BD7 1DP, Bradford, UK.
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