Serum anti-tumour antibodies and auto-antibodies in vitiligo

Type 3 autoimmune polyglandular syndrome (APS-3) or type 3 multiple autoimmune syndrome (MAS-3): an expanding galaxy

BACKGROUND

The number of recognised distinct autoimmune diseases (AIDs) has progressively increased over the years with more than 100 being reported today. The natural history of AIDs is characterized by progression from latent and subclinical to clinical stages and is associated with the presence of the specific circulating autoantibodies. Once presented, AIDs are generally chronic conditions. AIDs have the tendency to cluster and co-occur in a single patient. Autoimmune thyroid diseases (AITD) are the most prevalent of AIDs in the world population, and about one-third of the AITD patients also present with a non-thyroid AID during their life-span. Furthermore, patient with non-thyroid AIDs often presents with a form of AITD as a concurrent condition. Many of the clusters of AIDs are well characterized as distinctive syndromes, while some are infrequent and only described in case reports.

PURPOSE

In this review, we describe the wide spectrum of the combinations and the intricate relationships between AITD and the other AIDs, excluding Addison's disease. These combinations are collectively termed type 3 Autoimmune Polyglandular Syndrome (APS-3), also called type 3 Multiple Autoimmune Syndrome (MAS-3), and represent the most frequent APS in the world populations.

CONCLUSIONS

Numerous associations of AITD with various AIDs could be viewed as if the other AIDs were gravitating like satellites around AITD located in the center of a progressively expanding galaxy of autoimmunity.

Effect of Vitiligo on Auditory Functions: Is There Any Association?

Introduction  Vitiligo is an acquired pigmentary disorder of unknown etiology, clinically characterized by whitish macules caused by selective loss of melanocytes. There are many melanocytes in the human cochlea. Recent studies have suggested a direct relation between cochlear dysfunction and decreased amounts of melanin.

Objective  To determine the effect of vitiligo on auditory function.

Methods  The present prospective, case control study was performed over a period of 1 year in patients between 15 and 40 years old with nonsegmental disease and the same number of controls. Pure tone audiometry (PTA) and Otoacoustic emission (OAE) were performed to analyze the correlation between vitiligo and auditory function.

Results  The mean pure tone audiometric threshold in the right ear at 0.5, 8 kHz, and in the left ear at the frequency of 8 kHz in the case group were significantly higher as compared with controls. The average band reproducibility (%) in the right and left ear of controls was significantly higher at the frequency of 4 kHz as compared with cases. It has been observed that signal to noise ratio was statistically higher at the frequency of 5kHz in the right ear and at 2, 3, and 5kHz in the left ear in controls as compared with cases. On the basis of disease type and duration of disease; mean pure tone audiometric threshold, average band reproducibility and signal to noise ratio, no significant effect was observed in the present study.

Conclusion  Vitiligo has an effect on cochlear function irrespective of the duration or distribution of the disease.

Circulating autoantibodies and autoimmune comorbidities in vitiligo patients: a multicenter Italian study

BACKGROUND

Autoimmune comorbidities and circulating autoantibodies have been observed in vitiligo patients, but differences in rate are present according to countries in which the studies were performed, perhaps owing to ethnic diversities or different trigger factors.

OBJECTIVE

To estimate the prevalence of circulating autoantibodies and overt autoimmune diseases in a fairly large sample of Italian vitiligo patients.

METHODS

175 outpatients affected by vitiligo and referred to nine dermatological centers were included in the study. Patients were offered routine blood test, serological testing for thyroid function and search for autoantibodies.

RESULTS

At least one circulating autoantibody was detected in 61 (41.8%) of 146 subjects who underwent laboratory tests. Anti-thyroperoxidase (25.6%), anti-thyroglobulin (23.4%), antinuclear antibodies (16.8%) and anti-gastric parietal cell antibodies (7.8%) were the most noticed autoantibodies. 74 (41.5%) autoimmune comorbidities, mainly autoimmune thyroiditis (37%), were reported.

CONCLUSION

The prevalence of autoimmune comorbidities and circulating autoantibodies in this study was in agreement with other surveys conducted on Caucasian patients.

Increased incidence of antismooth muscle antibody in Korean vitiligo patients

To evaluate the incidence of autoimmune disorders and organ-specific autoantibodies in Korean vitiligo patients, antibodies to nuclear, mitochondrial, smooth muscle, gastric parietal cell, thyroglobulin, and microsomal antigens were screened in 226 vitiligo patients and 120 controls. Of the 226 vitiligo patients, three (1.3%) had thyrotoxicosis and two (0.8%) had diabetes mellitus. The vitiligo patients had an increased incidence of antinuclear (12.4%), antimicrosomal (7.1%), and antismooth muscle antibodies (25.7%). The increased incidence of antismooth muscle antibody was correlated with early onset (less than 15 years), a positive family history of vitiligo, and long duration of vitiligo. These results support an autoimmune origin of vitiligo and suggest that the high incidence of antismooth muscle antibody is a distinctive feature of laboratory findings in Korean vitiligo patients.

Psoriasis, necrobiosis lipoidica, granuloma annulare, vitiligo and skin infections in the same diabetic patient

A diabetic patient is described presenting psoriasis, necrobiosis lipoidica diabeticorum, granuloma annulare, and vitiligo and with a history of recurrent erysipelas and mycotic infections. Scrupulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.

Ocular pathology in the minimally depigmented subline of the vitiliginous Smyth chicken

Choroidal melanocytes and the retinal pigmented epithelium (RPE) were studied morphologically and histochemically in the Smyth chicken, an avian model for human vitiligo. The sequence of cytological events occurring in the ocular tissue of minimally depigmented Smyth birds was determined. Abnormalities of melanocytes and the associated inflammation was least severe in peripheral areas of the choroid and most pronounced in the back of the eye at the base of the optic nerve head. In the peripheral choroid, morphologically normal melanocytes and an occasional mononuclear leukocyte were observed. However, some of these morphologically normal melanocytes histochemically demonstrated atypical tyrosinase activity at the trans area of the Golgi apparatus. Toward the back of the eye, the melanocytes first appeared swollen and had retracting dendrites. Ultrastructurally these melanocytes demonstrated an increase in extramelanosomal cytoplasm. Later, melanocytes became spherical and had membrane bound, autophagosome-like compartments of pigment granules. As the melanocyte injury progressed, macrophages invaded the tissue and phagocytized melanocytic dendrites. These were followed by numerous plasma cells. Eventually, the back of the eye contained no pigment and was infiltrated with numerous mononuclear inflammatory cells. The retinal pigment epithelium also demonstrated a gradient in the degree of destruction, related to its topography. These cytological features consisted of the retraction of apical RPE processes, the disappearance of the basal plasma membrane infoldings, and the replacement of Bruch's membrane by collagen-like fibrils. These results demonstrate that the uveitis which develops in vitiligo appears to be a consequence of an inherent choroidal melanocyte defect.

Delayed-amelanotic (DAM or Smyth) chicken: melanocyte dysfunction in vivo and in vitro

Chickens of the autoimmune delayed-amelanotic (DAM or Smyth) line develop postnatal feather amelanosis and severe visual defects, both of which are presumed to be due to a dysfunction of melanocytes and a subsequent autoimmune response that eliminates pigment cells. In this report we elucidate further the melanocytic defect. We present a morphologic analysis of the mildly affected erratic (eDAM) group of Smyth chicken whose partial depigmentation and lack of visual impairment resemble human vitiligo more so than do the complete amelanosis and blindness in the classical Smyth line. Histologically, the sequential events leading to amelanosis in the young Smyth chicken occur simultaneously in the feathers of adult eDAM Smyth chickens, and the infiltration of the feather pulp with mononuclear leukocytes correlates with the extent of local pigmentary abnormality. Cytochemical localizations of dopa-oxidase and acid-phosphatase activities in eDAM feather melanocytes suggest that melanogenesis and autophagocytosis of melanosomes occur in tandem and that the rates of both are higher in these cells than in melanocytes of normally pigmented control chickens. Assays for tyrosinase activity in feather follicles indicate a hypermelanization in eDAM feathers and in the pigmented feathers of young Smyth chicks prior to the onset of depigmentation. Finally, we report on the establishment of pure, proliferative cultures of neural crest-derived melanocytes from control and Smyth chicken embryos. The degenerative events in Smyth chicken melanocyte cultures mimic in part those of the cells in vivo and are therefore indicative of a genetic defect that is independent of the immune system.

Tissue-specific autoantibodies and autoimmune disorders in vitiligo and alopecia areata: a retrospective study

We retrospectively analyzed our laboratory reports of tissue-specific autoantibodies (TSA) in 38 patients with alopecia areata (AA) and 31 patients with vitiligo. These reports were based on standard indirect immunofluorescence (IF) procedures, employing monkey tissues as substrates. One or more TSA were detected in 39% of serum samples. Thyroid (microsomal and/or thyroglobulin) antibodies had the highest occurrence rate and, as compared with the normal population, were detected at a greater frequency in both vitiligo and AA. Over half (58%) of our patients with vitiligo had one or more detectable TSA, while only 28% of patients with AA had such antibodies. When compared with the normal population, the occurrence rate of TSA was higher in patients with vitiligo. The only remarkable finding in AA was a higher than normal occurrence rate of antithyroid antibodies.

Antibodies to normal human melanocytes in vitiligo

Most patients with active vitiligo (82% of 61) have antibodies to antigens of normal human melanocytes that can be detected by specific immunoprecipitation of radioiodinated, detergent-soluble, melanocyte macromolecules. Such antibodies were present in only 12% of patients with melanoma and in none of 35 patients with nonpigmentary skin diseases. The antibodies were directed to a common antigen(s) on melanocytes that was not present on normal fibroblasts or keratinocytes. These observations suggest that vitiligo is an autoimmune disease mediated by antibodies to melanocyte-associated antigen(s).

Melanoma. Associated antigens in benign melanocytic disorders

Three instances of depigmentation occurring in children with congenital large nevocytic nevi are reported. Serologic studies for tumour-associated antigens to melanoma were performed by indirect immunofluorescence and complement fixation on these patients and others with benign melanocytic disorders. Positive reactivity in several children was observed. The small numbers studied and lack of uniformity of other testing methods leave open the question of relevance of such reactivity to malignant conversion or protection in congenital nevi.

Case report: malignant melanoma arising during drug therapy for vitiligo

A 30-year-old white male developed cutaneous patches of depigmentation which were treated with Trioxsalen ingested before daily sunbathing. A darkly pigmented lesion which appeared three weeks later on his back was widely excised and classified as a low-grade malignancy. Although the treatment of vitiligo with plants containing photodynamically active compounds dates back as far as 1400 BC, the modern period of research began only in the 1930's leading to the development of oral psoralens, a coumarin derivative. In early tests, patients showed increased sunlight tolerance and repigmentation of vitiliginous areas. Although some patients have developed uveitis and vitiligo while being treated for melanoma, previous published reports deny any cutaneous malignancy arising during drug therapy of vitiligo. The associations between vitiligo and melanoma are discussed. The possible causative role of Trioxsalen in etiology of the case presented is discussed.

Autoimmune vitiligo: detection of antibodies to melanin-producing cells

Vitiligo, a disorder characterized by the destruction of melanocytes, is often associated with diseases in which there are increased frequencies of autoantibodies. For this reason we investigated two patients with vitiligo, alopecia universalis, mucocutaneous candidiasis, and multiple endocrine insufficiencies for antibodies to melanin-producing cells. Using direct immunofluorescence of normal and vitiliginous skin from both patients and indirect immunofluorescence with both patients' serum, we could not detect these antibodies. However, an immunofluorescent complement-fixation test demonstrated a circulating antibody that bound to melanocytes in human skin, nevus cells and melanoma cells. Specificity of cellular fluorescence for nevus and melanoma cells was shown on serial sections stained with hematoxylin and eosin and was inferred for melanocytes from their distribution in human skin and their presence when the normal but not vitiliginous skin of both patients was used as substrate. This antibody was characterized as an IgG that activated complement via the classical pathway.

HL-A antigens and vitiligo

HL-A antigens were found with similar frequency in ninety vitiligo patients and in 341 healthy controls. However there was a significant correlation between HL-A13 and vitiligo with antithyroid antibodies. This supports the concept that vitiligo is a syndrome rather than a disease.