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Epigenetic Dysregulation in Autoimmune and Inflammatory Skin Diseases. Clin Rev Allergy Immunol 2022; 63:447-471. [DOI: 10.1007/s12016-022-08956-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
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Yu X, Cui Y, Zhu X, Xu H, Li L, Gao G. MicroRNAs: Emerging players in the pathogenesis of vitiligo. Front Cell Dev Biol 2022; 10:964982. [PMID: 36187493 PMCID: PMC9523438 DOI: 10.3389/fcell.2022.964982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Vitiligo is an autoimmune skin disease characterized by presence of pale patchy areas of depigmentation. MicroRNAs (miRNAs) are important regulators of gene expression and play significant roles in diverse biological and pathological processes. Accumulating evidence has shown that miRNAs were differentially expressed in skin lesions and peripheral blood mononuclear cells of patients with vitiligo. In particular, miRNAs are significantly correlated with the development and progression of vitiligo. The abundance of some miRNAs in serum was also correlated with the vitiligo lesion severity, indicating that miRNAs might serve as prognostic biomarkers. Importantly, the direct involvement of miRNAs in the pathogenesis of vitiligo has been demonstrated. For example, increased expression of miR-25 contributes to vitiligo through promoting the dysfunction and oxidative stress-induced destruction of melanocytes. However, there are limited studies on the function and mechanism of deregulated miRNAs in vitiligo. Further studies are required to establish clinical applications of miRNAs for vitiligo. More in-depth investigations of miRNAs are needed for the understanding of the pathogenesis of vitiligo and the development of novel therapeutic targets. This present review summarizes the current literature on the deregulation and pathogenic roles of miRNAs in vitiligo. We also highlight the potential clinical applications of miRNAs in patients with vitiligo.
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Affiliation(s)
| | | | | | | | - Linfeng Li
- *Correspondence: Linfeng Li, ; Guangcheng Gao,
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Plaza-Rojas L, Guevara-Patiño JA. The Role of the NKG2D in Vitiligo. Front Immunol 2021; 12:624131. [PMID: 33717132 PMCID: PMC7952755 DOI: 10.3389/fimmu.2021.624131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/02/2021] [Indexed: 12/16/2022] Open
Abstract
Vitiligo is an acquired multifactorial disease that affects melanocytes and results in skin depigmentation. In this review, we examine the role of cells stress and self-reactive T cells responses. Given the canonical and non-canonical functions of NKG2D, such as authenticating stressed target and enhance TCR signaling, we examine how melanocyte stress leads to the expression of ligands that are recognized by the activating receptor NKG2D, and how its signaling results in the turning of T cells against self (melanocyte suicide by proxy). We also discuss how this initiation phase is followed by T cell perpetuation, as NKG2D signaling results in self-sustained long-lasting T cells, with improved cytolytic properties.
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Affiliation(s)
- Lourdes Plaza-Rojas
- Department of Cancer Biology, Loyola University Chicago, Chicago, IL, United States
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Yan S, Shi J, Sun D, Lyu L. Current insight into the roles of microRNA in vitiligo. Mol Biol Rep 2020; 47:3211-3219. [PMID: 32086720 DOI: 10.1007/s11033-020-05336-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/18/2020] [Indexed: 12/11/2022]
Abstract
Vitiligo is a common chronic depigmented skin disease characterized by melanocyte loss or dysfunction in the lesion. The pathogenesis of vitiligo has not been fully clarified. Most studies have suggested that the occurrence and progression of vitiligo are due to multiple factors and gene interactions in which noncoding RNAs contribute to an individual's susceptibility to vitiligo. Noncoding RNAs, including microRNAs (miRNAs), are a hot topic in posttranscriptional regulatory mechanism research. miRNAs are noncoding RNAs with a length of approximately 22 nucleotides and play a negative regulatory role by binding to the 3'-UTR or 5'-UTR of the target mRNA to inhibit translation or initiate mRNA degradation. Previous studies have screened the differential expression profiles of miRNAs in the skin lesions, melanocytes, peripheral blood mononuclear cells (PBMCs) and sera of patients and mouse models with vitiligo. Moreover, several studies have focused on miRNA-25, miRNA-155 and other miRNAs involved in melanin metabolism, oxidative stress, and melanocyte proliferation and apoptosis. These miRNAs and regulatory processes further illuminate the pathogenesis of vitiligo and provide hope for the application of small molecules in the treatment of vitiligo. In this review, we summarize miRNA expression profiles in different tissues of vitiligo patients and the mechanisms by which key miRNAs mediate vitiligo development.
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Affiliation(s)
- Shili Yan
- Science and Technology Achievement Incubation Center, Kunming Medical University, 1168 West Chunrong Road, Yuhua Avenue, Chenggong District, Kunming, 650500, Yunnan, China
- Department of Dermatology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingpei Shi
- Science and Technology Achievement Incubation Center, Kunming Medical University, 1168 West Chunrong Road, Yuhua Avenue, Chenggong District, Kunming, 650500, Yunnan, China
- School of Basic Medical Sciences, Kunming Medical University, Kunming, China
| | - Dongjie Sun
- Department of Dermatology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lechun Lyu
- Science and Technology Achievement Incubation Center, Kunming Medical University, 1168 West Chunrong Road, Yuhua Avenue, Chenggong District, Kunming, 650500, Yunnan, China.
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Melanoma and Vitiligo: In Good Company. Int J Mol Sci 2019; 20:ijms20225731. [PMID: 31731645 PMCID: PMC6888090 DOI: 10.3390/ijms20225731] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022] Open
Abstract
Cutaneous melanoma represents the most aggressive form of skin cancer, whereas vitiligo is an autoimmune disorder that leads to progressive destruction of skin melanocytes. However, vitiligo has been associated with cutaneous melanoma since the 1970s. Most of the antigens recognized by the immune system are expressed by both melanoma cells and normal melanocytes, explaining why the autoimmune response against melanocytes that led to vitiligo could be also present in melanoma patients. Leukoderma has been also observed as a side effect of melanoma immunotherapy and has always been associated with a favorable prognosis. In this review, we discuss several characteristics of the immune system responses shared by melanoma and vitiligo patients, as well as the significance of occurrence of leukoderma during immunotherapy, with special attention to check-point inhibitors.
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Qi Y, Li J. RETRACTED: Triptolide inhibits the growth and migration of colon carcinoma cells by down-regulation of miR-191. Exp Mol Pathol 2019; 107:23-31. [PMID: 30684462 DOI: 10.1016/j.yexmp.2019.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 12/22/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. Concerns were raised about the background pattern of the Western Blots from Figure 2A. Given the comments of Dr Elisabeth Bik regarding this article “This paper belongs to a set of over 400 papers (as per February 2020) that share very similar Western blots with tadpole-like shaped bands, the same background pattern, and striking similarities in title structures, paper layout, bar graph design, and - in a subset - flow cytometry panels”, the journal requested the authors to provide the raw data. However, the authors were not able to fulfil this request and therefore the Editor-in-Chief decided to retract the article.
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Affiliation(s)
- Yuxi Qi
- Department of Anorectal Surgery, Jining No.1 People's Hospital, Jining 272011, China; Affiliated Jining No.1 People's Hospital of Jining Medical University, Jining Medical University, Jining 272067, China
| | - Jinliang Li
- Department of Anorectal Surgery, Jining No.1 People's Hospital, Jining 272011, China.
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Willinger CM, Rong J, Tanriverdi K, Courchesne PL, Huan T, Wasserman GA, Lin H, Dupuis J, Joehanes R, Jones MR, Chen G, Benjamin EJ, O’Connor GT, Mizgerd JP, Freedman JE, Larson MG, Levy D. MicroRNA Signature of Cigarette Smoking and Evidence for a Putative Causal Role of MicroRNAs in Smoking-Related Inflammation and Target Organ Damage. CIRCULATION. CARDIOVASCULAR GENETICS 2017; 10:e001678. [PMID: 29030400 PMCID: PMC5683429 DOI: 10.1161/circgenetics.116.001678] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cigarette smoking increases risk for multiple diseases. MicroRNAs regulate gene expression and may play a role in smoking-induced target organ damage. We sought to describe a microRNA signature of cigarette smoking and relate it to smoking-associated clinical phenotypes, gene expression, and lung inflammatory signaling. METHODS AND RESULTS Expression profiling of 283 microRNAs was conducted on whole blood-derived RNA from 5023 Framingham Heart Study participants (54.0% women; mean age, 55±13 years) using TaqMan assays and high-throughput reverse transcription quantitative polymerase chain reaction. Associations of microRNA expression with smoking status and associations of smoking-related microRNAs with inflammatory biomarkers and pulmonary function were tested with linear mixed effects models. We identified a 6-microRNA signature of smoking. Five of the 6 smoking-related microRNAs were associated with serum levels of C-reactive protein or interleukin-6; miR-1180 was associated with pulmonary function measures at a marginally significant level. Bioinformatic evaluation of smoking-associated genes coexpressed with the microRNA signature of cigarette smoking revealed enrichment for immune-related pathways. Smoking-associated microRNAs altered expression of selected inflammatory mediators in cell culture gain-of-function assays. CONCLUSIONS We characterized a novel microRNA signature of cigarette smoking. The top microRNAs were associated with systemic inflammatory markers and reduced pulmonary function, correlated with expression of genes involved in immune function, and were sufficient to modulate inflammatory signaling. Our results highlight smoking-associated microRNAs and are consistent with the hypothesis that smoking-associated microRNAs serve as mediators of smoking-induced inflammation and target organ damage. These findings call for further mechanistic studies to explore the diagnostic and therapeutic use of smoking-related microRNAs.
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Affiliation(s)
- Christine M. Willinger
- Framingham Heart Study, Framingham, MA
- Division of Intramural Research and Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Jian Rong
- Framingham Heart Study, Framingham, MA
- Boston University School of Public Health, Boston
| | - Kahraman Tanriverdi
- Department of Medicine and UMass Memorial Heart & Vascular Center, University of Massachusetts Medical School, Worcester
| | - Paul L. Courchesne
- Framingham Heart Study, Framingham, MA
- Division of Intramural Research and Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Tianxiao Huan
- Framingham Heart Study, Framingham, MA
- Division of Intramural Research and Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | | | - Honghuang Lin
- Framingham Heart Study, Framingham, MA
- Boston University School of Medicine
| | - Josée Dupuis
- Framingham Heart Study, Framingham, MA
- Boston University School of Public Health, Boston
| | - Roby Joehanes
- Framingham Heart Study, Framingham, MA
- Division of Intramural Research and Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - George Chen
- Framingham Heart Study, Framingham, MA
- Division of Intramural Research and Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Emelia J. Benjamin
- Framingham Heart Study, Framingham, MA
- Boston University School of Public Health, Boston
- Boston University School of Medicine
| | | | | | - Jane E. Freedman
- Department of Medicine and UMass Memorial Heart & Vascular Center, University of Massachusetts Medical School, Worcester
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Boston University School of Public Health, Boston
| | - Daniel Levy
- Framingham Heart Study, Framingham, MA
- Division of Intramural Research and Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
- Boston University School of Medicine
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Shang Z, Li H. Altered expression of four miRNA (miR-1238-3p, miR-202-3p, miR-630 and miR-766-3p) and their potential targets in peripheral blood from vitiligo patients. J Dermatol 2017; 44:1138-1144. [PMID: 28500632 DOI: 10.1111/1346-8138.13886] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/17/2017] [Indexed: 12/17/2022]
Abstract
Vitiligo is an acquired skin disease with pigmentary disorder. Autoimmune destruction of melanocytes is thought to be major factor in the etiology of vitiligo. miRNA-based regulators of gene expression have been reported to play crucial roles in autoimmune disease. Therefore, we attempt to profile the miRNA expressions and predict their potential targets, assessing the biological functions of differentially expressed miRNA. Total RNA was extracted from peripheral blood of vitiligo (experimental group, n = 5) and non-vitiligo (control group, n = 5) age-matched patients. Samples were hybridized to a miRNA array. Box, scatter and principal component analysis plots were performed, followed by unsupervised hierarchical clustering analysis to classify the samples. Quantitative reverse transcription polymerase chain reaction (RT-PCR) was conducted for validation of microarray data. Three different databases, TargetScan, PITA and microRNA.org, were used to predict the potential target genes. Gene ontology (GO) annotation and pathway analysis were performed to assess the potential functions of predicted genes of identified miRNA. A total of 100 (29 upregulated and 71 downregulated) miRNA were filtered by volcano plot analysis. Four miRNA were validated by quantitative RT-PCR as significantly downregulated in the vitiligo group. The functions of predicted target genes associated with differentially expressed miRNA were assessed by GO analysis, showing that the GO term with most significantly enriched target genes was axon guidance, and that the axon guidance pathway was most significantly correlated with these miRNA. In conclusion, we identified four downregulated miRNA in vitiligo and assessed the potential functions of target genes related to these differentially expressed miRNA.
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Affiliation(s)
- Zhiwei Shang
- Department of Dermatology, The First Affiliated Hospital, and College of Clinical Medicine of Zhengzhou University, Zhengzhou, China.,Department of Dermatology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Hongwen Li
- Department of Dermatology, The First Affiliated Hospital, and College of Clinical Medicine of Zhengzhou University, Zhengzhou, China
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Sahoo A, Lee B, Boniface K, Seneschal J, Sahoo SK, Seki T, Wang C, Das S, Han X, Steppie M, Seal S, Taieb A, Perera RJ. MicroRNA-211 Regulates Oxidative Phosphorylation and Energy Metabolism in Human Vitiligo. J Invest Dermatol 2017; 137:1965-1974. [PMID: 28502800 DOI: 10.1016/j.jid.2017.04.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/19/2017] [Accepted: 04/27/2017] [Indexed: 01/02/2023]
Abstract
Vitiligo is a common chronic skin disorder characterized by loss of epidermal melanocytes and progressive depigmentation. Vitiligo has complex immune, genetic, environmental, and biochemical causes, but the exact molecular mechanisms of vitiligo development and progression, particularly those related to metabolic control, are poorly understood. In this study we characterized the human vitiligo cell line PIG3V and the normal human melanocyte line HEM-l by RNA sequencing, targeted metabolomics, and shotgun lipidomics. Melanocyte-enriched microRNA-211, a known metabolic switch in nonpigmented melanoma cells, was severely down-regulated in vitiligo cell line PIG3V and skin biopsy samples from vitiligo patients, whereas its predicted targets PPARGC1A, RRM2, and TAOK1 were reciprocally up-regulated. microRNA-211 binds to PGC1-α 3' untranslated region locus and represses it. Although mitochondrial numbers were constant, mitochondrial complexes I, II, and IV and respiratory responses were defective in vitiligo cells. Nanoparticle-coated microRNA-211 partially augmented the oxygen consumption rate in PIG3V cells. The lower oxygen consumption rate, changes in lipid and metabolite profiles, and increased reactive oxygen species production observed in vitiligo cells appear to be partly due to abnormal regulation of microRNA-211 and its target genes. These genes represent potential biomarkers and therapeutic targets in human vitiligo.
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Affiliation(s)
- Anupama Sahoo
- Sanford Burnham Prebys Medical Discovery Institute, 6400 Sanger Road, Orlando, Florida, USA
| | - Bongyong Lee
- Sanford Burnham Prebys Medical Discovery Institute, 6400 Sanger Road, Orlando, Florida, USA
| | - Katia Boniface
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France; Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France; Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France
| | - Sanjaya K Sahoo
- Sanford Burnham Prebys Medical Discovery Institute, 6400 Sanger Road, Orlando, Florida, USA
| | - Tatsuya Seki
- Sanford Burnham Prebys Medical Discovery Institute, 6400 Sanger Road, Orlando, Florida, USA; Medical and Biological Laboratories, Nagoya, Japan
| | - Chunyan Wang
- Sanford Burnham Prebys Medical Discovery Institute, 6400 Sanger Road, Orlando, Florida, USA
| | - Soumen Das
- Advanced Materials Processing and Analysis Center, Nanoscience and Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Xianlin Han
- Sanford Burnham Prebys Medical Discovery Institute, 6400 Sanger Road, Orlando, Florida, USA
| | - Michael Steppie
- Department of Dermatology, Florida State University College of Medicine, Orlando Regional Campus, Orlando, Florida, USA
| | - Sudipta Seal
- Advanced Materials Processing and Analysis Center, Nanoscience and Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France; Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France
| | - Ranjan J Perera
- Sanford Burnham Prebys Medical Discovery Institute, 6400 Sanger Road, Orlando, Florida, USA.
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Liu Q, Wu DH, Han L, Deng JW, Zhou L, He R, Lu CJ, Mi QS. Roles of microRNAs in psoriasis: Immunological functions and potential biomarkers. Exp Dermatol 2017; 26:359-367. [PMID: 27783430 PMCID: PMC5837862 DOI: 10.1111/exd.13249] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Abstract
MicroRNAs (miRNAs) are small non-coding RNA molecules, which function in RNA silencing and post-transcriptional regulation of gene expression. Psoriasis is an inflammatory skin disease characterized by the dysfunction of keratinocytes, with the immune dysregulation. We reviewed the recent studies on the roles of miRNAs in psoriasis and showed that miRNAs play key roles in psoriasis, including the regulation of hyperproliferation, cytokine and chemokine production in keratinocyte, as well as mediating immune dysfunction in psoriasis. Furthermore, miRNAs, particularly, circulating miRNAs may serve as novel biomarkers for diagnosis, monitoring therapy response and reflecting the disease severity. Thus, targeting specific miRNAs may be used to develop new therapeutic methods for psoriasis.
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Affiliation(s)
- Qing Liu
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Immunology, School of medicine, Fudan University, Shanghai, China
| | - Ding-Hong Wu
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Henry Ford Immunology Program, Henry Ford Health System, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Ling Han
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Henry Ford Immunology Program, Henry Ford Health System, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Jing-Wen Deng
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Henry Ford Immunology Program, Henry Ford Health System, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Li Zhou
- Henry Ford Immunology Program, Henry Ford Health System, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Rui He
- Department of Immunology, School of medicine, Fudan University, Shanghai, China
| | - Chuan-Jian Lu
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing-Sheng Mi
- Henry Ford Immunology Program, Henry Ford Health System, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
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