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Van Acker MM, Schwartz RR, Andrews K, Seiffert-Sinha K, Sinha AA. Inheritance-Specific Dysregulation of Th1- and Th17-Associated Cytokines in Alopecia Areata. Biomolecules 2023; 13:1285. [PMID: 37759685 PMCID: PMC10527519 DOI: 10.3390/biom13091285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Autoimmune diseases tend to cluster in families, suggesting genetic predisposition to autoimmunity associated with familial background. We have previously reported similarities in gene expression patterns and PTPN22 polymorphisms between alopecia areata (AA) patients and their healthy relatives, but not unrelated healthy controls. However, the spectrum of disease promoting (or preventing) pathways that may be activated in blood relatives of AA patients remains to be defined. Here, we investigated the extent to which cytokines associated with the Th1 and Th17 pathway are differentially expressed in the blood of patients with AA and its clinical subtypes in comparison to both healthy relatives as well as unrelated healthy controls. A comprehensive set of Th1- and Th17-related cytokines were evaluated by ELISA. We found a significant elevation of the Th17 inducer IL-23, the Th17 product IL-17A, the Th1 hallmark cytokine IFNγ, and TNFα, a Th1 cytokine with relevance to the Th17 pathway in AA patients, regardless of disease subtype, compared to healthy individuals. On further examination, we found that healthy family members grouped together with patients in terms of elevated Th1- and Th17-pathway cytokines in an inheritance-specific manner, distinct from unrelated controls. The elevation of Th17-associated cytokines in healthy controls related to AA patients indicates that Th1 and Th17 dysregulation in AA may be genetically based. Of note, one unrelated control displayed elevated levels of IL-17A and IL-23 similar to those detected in patients. One year after initial blood draw, areas of beard hair loss consistent with the diagnosis of AA were reported by this individual, indicating that the elevation in Th17-related cytokines may have predictive value.
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Affiliation(s)
| | | | | | | | - Animesh A. Sinha
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
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Zeng Z, Li S, Ye Y, Ling Y, Gong Y, Zi X, Yang J, McElwee KJ, Zhang X. Allergen desensitization reduces the severity of relapsed alopecia areata in dust-mite allergic patients. Exp Dermatol 2023. [PMID: 37114716 DOI: 10.1111/exd.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Atopy may be a facilitating factor in some alopecia areata (AA) patients with early disease onset and more severe/extensive AA. The underlying immune mechanisms are unknown, but allergen responses may support a pro-inflammatory environment that indirectly promotes AA. To investigate the long-term effect of allergen immunotherapy (AIT) against house dust mite (HDM) allergy on disease severity and prognosis for AA patients. An observational comparative effectiveness study was conducted on 69 AA patients with HDM allergy. 34 patients received conventional/traditional AA treatment (TrAA) plus AIT (AIT-TrAA), and 35 patients received TrAA alone. Serum total immunoglobulin E (tIgE), HDM specific IgE (sIgE), HDM specific IgG4 (sIgG4) and cytokines (IL-4, IL-5, IL-10, IL-12, IL-13, IL-33, IFNγ) were quantified in these patients, together with 58 non-allergic AA patients and 40 healthy controls. At the end of the 3-year desensitization course, the AIT-TrAA group presented with lower SALT scores than the TrAA group, especially in non-alopecia totalis/universalis (AT/U) patients and pre-adolescent AT/U patients (age ≤ 14). In patients with elevated tIgE levels before AIT, a decrease in tIgE was correlated to reduced extent of AA on completion of the AIT course. After desensitization, elevation of IL-5 and decrease of IL-33 were observed in HDM allergic-AA patients. Desensitization to HDM in allergic AA patients reduces the severity of relapse-related hair loss over the 3-year AIT treatment course, possibly via opposing Th2 dominance. This adjunctive treatment may help reduce disease severity and curtail the disease process in allergic patients with AA.
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Affiliation(s)
- Zixun Zeng
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, P.R. China
| | - Shuifeng Li
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yanting Ye
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yunxia Ling
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yugang Gong
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Xue Zi
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Jian Yang
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Kevin J McElwee
- Centre for Skin Sciences, University of Bradford, Bradford, UK
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xingqi Zhang
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
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Ozyurtlu F, Cetin N. Alopecia Universalis after Treatment with Simvastatin and Ezetimibe: Affects on Family. Arq Bras Cardiol 2022; 119:631-633. [PMID: 36287418 PMCID: PMC9563873 DOI: 10.36660/abc.20220187] [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: 11/30/2021] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
A alopecia areata (AA) é uma doença autoimune que se desenvolve no couro cabeludo ou em outras partes do corpo. A alopecia universal, que é uma forma rara de alopecia areata, é caracterizada pela perda de pelos que afeta todo o corpo. Nos dois pacientes apresentados, o tratamento com atorvastatina foi iniciado com o diagnóstico de hipercolesterolemia, mas, quando as metas de valores não foram alcançadas, foi iniciado o tratamento com uma combinação de sinvastatina e ezetimiba. Depois de um período de tratamento com sinvastatina e ezetimiba, o distúrbio de AA, o qual começou com a perda de cabelo no couro cabeludo, espalhou pelo corpo todo e se transformou em alopecia universal. Embora as estatinas possam causar alopecia com reações autoimunes, elas geralmente são utilizadas no tratamento da alopecia, por seus efeitos imunomoduladores.
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Affiliation(s)
- Ferhat Ozyurtlu
- Special Grand Medical Hospital - Department of Cardiology , Manisa - Turquia
| | - Nurullah Cetin
- Celal Bayar University Faculty of Medicine , Department of Cardiology , Manisa - Turquia
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Lensing M, Jabbari A. An overview of JAK/STAT pathways and JAK inhibition in alopecia areata. Front Immunol 2022; 13:955035. [PMID: 36110853 PMCID: PMC9470217 DOI: 10.3389/fimmu.2022.955035] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Alopecia Areata (AA) is a common autoimmune disease characterized by non-scarring hair loss ranging from patches on the scalp to complete hair loss involving the entire body. Disease onset is hypothesized to follow the collapse of immune privilege of the hair follicle, which results in an increase in self-peptide/MHC expression along the follicular epithelium. Hair loss is associated with infiltration of the hair follicle with putatively self-reactive T cells. This process is thought to skew the hair follicle microenvironment away from a typically homeostatic immune state towards one of active inflammation. This imbalance is mediated in part by the dominating presence of specific cytokines. While interferon-γ (IFNγ) has been identified as the key player in AA pathogenesis, many other cytokines have also been shown to play pivotal roles. Mechanistic studies in animal models have highlighted the contribution of common gamma chain (γc) cytokines such as IL-2, IL-7, and IL-15 in augmenting disease. IFNγ and γc cytokines signal through pathways involving receptor activation of Janus kinases (JAKs) and signal transducers and activators of transcription (STATs). Based on these findings, JAK/STAT pathways have been targeted for the purposes of therapeutic intervention in the clinical setting. Case reports and series have described use of small molecule JAK inhibitors leading to hair regrowth among AA patients. Furthermore, emerging clinical trial results show great promise and position JAK inhibitors as a treatment strategy for patients with severe or recalcitrant disease. Demonstrated efficacy from large-scale clinical trials of the JAK inhibitor baricitinib led to the first-in-disease FDA-approved treatment for AA in June of 2022. This review aims to highlight the JAK/STAT signaling pathways of various cytokines involved in AA and how targeting those pathways may impact disease outcomes in both laboratory and clinical settings.
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Affiliation(s)
- Maddison Lensing
- Department of Dermatology, University of Iowa, Iowa City, IA, United States
- Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, United States
| | - Ali Jabbari
- Department of Dermatology, University of Iowa, Iowa City, IA, United States
- Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, United States
- Iowa City Veterans Affairs (VA) Medical Center, Iowa City, IA, United States
- *Correspondence: Ali Jabbari,
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Connell SJ, Jabbari A. The current state of knowledge of the immune ecosystem in alopecia areata. Autoimmun Rev 2022; 21:103061. [PMID: 35151885 PMCID: PMC9018517 DOI: 10.1016/j.autrev.2022.103061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 12/18/2022]
Abstract
Alopecia areata (AA) is an autoimmune disease that affects approximately 2% of the general population. Patients with AA most commonly present with one or more patches of hair loss on the scalp in defined circular areas. A fraction of patients progress to more severe forms of the disease, in some cases with involvement of all body surfaces. The healthy anagen stage hair follicle is considered an immune privileged site, described as an environment that suppresses inflammatory immune responses. However, in AA, this immune privileged state collapses and marks the hair follicle as a target for the immune system, resulting in peri- and intrafollicular infiltration by lymphocytes. The complexity of the inflammatory ecosystem of the immune response to the hair follicle, and the relationships between the cellular and soluble participants, in AA remains incompletely understood. Many studies have demonstrated the presence of various immune cells around diseased hair follicles; however, often little is known about their respective contributions to AA pathogenesis. Furthering our understanding of the mechanisms of disease in AA is essential for the novel identification of targeted therapeutics that are efficacious and have few unintended effects.
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Rajabi F, Abdollahimajd F, Jabalameli N, Nassiri Kashani M, Firooz A. The Immunogenetics of Alopecia areata. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:19-59. [DOI: 10.1007/978-3-030-92616-8_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Waśkiel-Burnat A, Osińska M, Salińska A, Blicharz L, Goldust M, Olszewska M, Rudnicka L. The Role of Serum Th1, Th2, and Th17 Cytokines in Patients with Alopecia Areata: Clinical Implications. Cells 2021; 10:3397. [PMID: 34943905 PMCID: PMC8699846 DOI: 10.3390/cells10123397] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
Alopecia areata is a type of non-scarring hair loss. The dysregulation of numerous systemic Th1 (IL-2, IFN-γ, TNF, IL-12, and IL-18), Th2 (IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17E, IL-31 and IL-33) and Th17 (IL-17, IL-17F, IL-21, IL-22, IL-23 and TGF-β) cytokines was observed in patients with alopecia areata. Positive correlations between the severity of alopecia areata and an increased serum level of various cytokines including IL-2, TNF, IL-12, IL-17, and IL-17E were reported in the literature. An increased serum level of numerous cytokines, such as IL-2, IL-6, TNF, IL-12, IL-17E, and IL-22, was described as positively correlated with the duration of the disease. Moreover, it was shown that increased pre-treatment serum level of IL-12 was a positive, while increased serum levels of IL-4 and IL-13 were negative prognostic markers for the efficacy of diphenylcyclopropenone. In conclusion, alopecia areata is associated with the dysregulation of systemic Th1, Th2 and Th17 cytokines with their role in the pathogenesis, clinical manifestations and prognosis of the disease. Available data indicate the most significant role of serum IL-2, TNF, IL-12, IL-17, and IL-17E as markers of disease activity. The serum levels IL-4, IL-12 and IL-13 may be useful as potential predictors of diphenylcyclopropenone efficacy.
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Affiliation(s)
- Anna Waśkiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Marta Osińska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Anna Salińska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Małgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
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Glickman JW, Dubin C, Dahabreh D, Han J, Del Duca E, Estrada YD, Zhang N, Kimmel GW, Singer G, Krueger JG, Pavel AB, Guttman‐Yassky E. An integrated scalp and blood biomarker approach suggests the systemic nature of alopecia areata. Allergy 2021; 76:3053-3065. [PMID: 33721346 DOI: 10.1111/all.14814] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alopecia areata (AA) is characterized by immune dysregulation in both scalp and blood, but a large-scale approach establishing biomarkers of AA incorporating both scalp tissue and serum compartments is lacking. We aimed to characterize the transcriptomic signature of AA lesional and nonlesional scalp compared to healthy scalp and determine its relationship with the blood proteome in the same individuals, with comparative correlations to clinical AA disease severity. METHODS We evaluated lesional and nonlesional scalp tissues and serum from patients with moderate-to-severe AA (n = 18) and healthy individuals (n = 8). We assessed 33,118 genes in AA scalp tissue using RNAseq transcriptomic evaluation and 340 inflammatory proteins in serum using OLINK high-throughput proteomics. Univariate and multivariate approaches were used to correlate disease biomarkers with Severity of Alopecia Tool (SALT). RESULTS A total of 608 inflammatory genes were differentially expressed in lesional AA scalp (fold change/FCH>1.5, false discovery rate/FDR<0.05) including Th1 (IFNG/IL12B/CXCL11), Th2 (IL13/CCL18), and T-cell activation-related (ICOS) products. Th1/Th2-related markers were significantly correlated with AA clinical severity in lesional/nonlesional tissue, while keratins (KRT35/KRT83/KRT81) were significantly downregulated in lesional compared to healthy scalp (p < .05). Expression of cardiovascular/atherosclerosis-related markers (MMP9/CCL2/IL1RL1/IL33R/ST2/AGER) in lesional scalp correlated with their corresponding serum expression (p < .05). AA scalp demonstrated significantly greater biomarker dysregulation compared to blood. An integrated multivariate approach combining scalp and serum biomarkers improved correlations with disease severity/SALT. CONCLUSION This study contributes a unique understanding of the phenotype of moderate-to-severe AA with an integrated scalp and serum biomarker model suggesting the systemic nature of the disease, advocating for the need for immune-based systemic treatment.
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Affiliation(s)
- Jacob W. Glickman
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Celina Dubin
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Dante Dahabreh
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Joseph Han
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ester Del Duca
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Yeriel D. Estrada
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ning Zhang
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Grace W. Kimmel
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Giselle Singer
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - James G. Krueger
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| | - Ana B. Pavel
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Biomedical Engineering The University of Mississippi University MS USA
| | - Emma Guttman‐Yassky
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
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Omar SI, Hamza AM, Eldabah N, Habiba DA. IFN-α and TNF-α serum levels and their association with disease severity in Egyptian children and adults with alopecia areata. Int J Dermatol 2021; 60:1397-1404. [PMID: 34008204 DOI: 10.1111/ijd.15658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune skin disease characterized by abnormal levels of several cytokines, such as interferon alpha (IFN-α) and tumor necrosis factor-alpha (TNF-α), which are T-helper type 1 cytokines that have important roles in the pathogenesis of AA. The aim of our study was to correlate circulating IFN-α and TNF-α levels with disease severity, activity, and clinical type in patients with AA and to evaluate the relationship between the two cytokines. METHODS We investigated serum IFN-α and TNF-α levels in 72 patients with AA (35 children and 35 adults) and 75 healthy control individuals (34 children and 41 adults) using the enzyme-linked immunosorbent assay (ELISA) technique. We evaluated AA severity using the Severity of Alopecia Tool (SALT) and determined the activity based on dermoscopic criteria of disease activity. RESULTS Serum IFN-α and TNF-α concentrations were significantly higher in the patients than in the controls. There was a significant positive correlation between serum IFN-α and TNF-α levels in all patients with alopecia areata, as well as between serum TNF-α levels and disease severity in all patients and in children. CONCLUSIONS Our results support the association between IFN-α and TNF-α levels and AA and suggest that TNF-α might be related to disease severity.
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Affiliation(s)
- Shaimaa I Omar
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ashraf M Hamza
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nermeen Eldabah
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Doaa A Habiba
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Mahasaksiri T, Kositkuljorn C, Anuntrangsee T, Suchonwanit P. Application of Topical Immunotherapy in the Treatment of Alopecia Areata: A Review and Update. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:1285-1298. [PMID: 33790540 PMCID: PMC8001176 DOI: 10.2147/dddt.s297858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/09/2021] [Indexed: 12/13/2022]
Abstract
Treatment of extensive or recalcitrant alopecia areata (AA) is a major clinical challenge. Even after thorough investigation of several medications, its treatment outcomes have remained unsatisfactory. While there is no US Food and Drug Administration-approved medication for AA yet, topical immunotherapy has been a well-documented treatment option. Dinitrochlorobenzene, squaric acid dibutylester, and diphenylcyclopropenone are three substances that have demonstrated efficacy in the treatment of extensive or recalcitrant AA. Despite being commonly used, the mechanism underlying topical immunotherapy is not well-elucidated and a wide range of clinical efficacies have been reported in the literature. The aim of this review was to summarize and update the pharmacology, mechanism of action, therapeutic efficacy, and tolerability of topical immunotherapy in the treatment of AA.
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Affiliation(s)
- Thipprapai Mahasaksiri
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanaporn Anuntrangsee
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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11
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Ito T, Kageyama R, Nakazawa S, Honda T. Understanding the significance of cytokines and chemokines in the pathogenesis of alopecia areata. Exp Dermatol 2020; 29:726-732. [DOI: 10.1111/exd.14129] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Taisuke Ito
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Reiko Kageyama
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Shinsuke Nakazawa
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Tetsuya Honda
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
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12
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Gautam RK, Singh Y, Gupta A, Arora P, Khurana A, Chitkara A. The profile of cytokines (IL‐2, IFN‐γ, IL‐4, IL‐10, IL‐17A, and IL‐23) in active alopecia areata. J Cosmet Dermatol 2019; 19:234-240. [DOI: 10.1111/jocd.12970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/25/2018] [Accepted: 03/26/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Ram Kishan Gautam
- Department of Dermatology Post graduate institute of medical education and research, Dr Ram Manohar Lohia Hospital New Delhi India
| | - Yogita Singh
- Department of Dermatology Post graduate institute of medical education and research, Dr Ram Manohar Lohia Hospital New Delhi India
| | - Aastha Gupta
- Department of Dermatology Post graduate institute of medical education and research, Dr Ram Manohar Lohia Hospital New Delhi India
| | - Pooja Arora
- Department of Dermatology Post graduate institute of medical education and research, Dr Ram Manohar Lohia Hospital New Delhi India
| | - Ananta Khurana
- Department of Dermatology Post graduate institute of medical education and research, Dr Ram Manohar Lohia Hospital New Delhi India
| | - Anubhuti Chitkara
- Department of Biochemistry Post graduate institute of medical education and research, Dr Ram Manohar Lohia Hospital New Delhi India
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13
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Sung CT, Choi FD, Juhász M, Mesinkovska NA. The Immunological Association between Alopecia Areata and Respiratory Diseases: A Systematic Review. Skin Appendage Disord 2019; 5:230-237. [PMID: 31367601 DOI: 10.1159/000496445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022] Open
Abstract
Background While alopecia areata (AA) has been associated with atopy, the immunological relationship is unclear, with the association of specific atopic and systemic respiratory diseases not established. The relationship between T-helper (Th)1-mediated AA and Th2-mediated atopy challenges the conventional Th1/Th2 paradigm of autoimmune disease categorization. Objectives To determine the association between AA and atopic respiratory diseases in adults and children, and respiratory diseases in general. Method All primary literature, excluding case reports, were identified within PubMed/MEDLINE, CINAHL, and Web of Science in May 2018 using the following search terms: "(alopecia OR hair loss) AND (respiratory OR pulmonary OR lungs OR asthma OR rhinitis OR bronchitis OR COPD OR atopy OR atopic)." Information from 32 articles meeting the inclusion and exclusion criteria was reviewed. Results Among the 32 articles identified for inclusion, the prevalence of AA was more strongly associated with allergic rhinitis compared to asthma among pediatric and adult populations. While a significant association was identified between AA, allergic rhinitis, and a late age of onset, the association of AA and asthma remains controversial despite asthma's prevalence among AA patients. No significant difference was identified with regard to the association of AA and non-atopic respiratory diseases between adult and pediatric patients. Conclusions Adult and pediatric patients with AA warrant further workup for atopic respiratory diseases such as allergic rhinitis. AA may have an underlying Th2-mediated immunological component, which supports its association with atopic respiratory diseases and provides a new avenue for targeted therapies in select cases.
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Affiliation(s)
- Calvin T Sung
- Department of Dermatology, University of California, Irvine, Irvine, California, USA.,School of Medicine, University of California, Riverside, Riverside, California, USA
| | - Franchesca D Choi
- Department of Dermatology, University of California, Irvine, Irvine, California, USA.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Margit Juhász
- Department of Dermatology, University of California, Irvine, Irvine, California, USA
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14
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Serum concentrations of selected proinflammatory cytokines in children with alopecia areata. Postepy Dermatol Alergol 2019; 36:63-69. [PMID: 30858781 PMCID: PMC6409873 DOI: 10.5114/ada.2019.82826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/26/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction Alopecia areata (AA) is considered an autoimmune disorder characterized by patchy loss of hair from the scalp and other body parts. Many patients develop the disease in childhood. Aim To answer the question whether abnormal production of some proinflammatory cytokines (IL-2, IL-6, IL-15, IL-17A and IFNγ) in children with AA may facilitate the development or progression of the disease. Material and methods The study group consisted of 42 children with AA, the control group – 37 healthy children. Peripheral venous blood samples were collected from patients with AA and healthy controls and the concentrations of serum cytokines, namely IL-2, IL-6, IL-15, IL-17A, IFN-γ were determined quantitatively by ELISA method. Results The serum IL-6, IL-15, IL-17A and IFNγ levels were significantly increased in patients with AA compared with control subjects (p < 0.05). The serum IL-15 level was found to be increased when the total duration of AA was increased (q = 0.30; p = 0.05). The serum cytokine level of IL-17A was found to be decreased when duration of the current episode was longer than 2 years (p < 0.05), but the correlation between IL-17A serum level and duration of the current episode was not confirmed in the Spearman test (q = –0.06; p = 0.68). The serum IL-17A level was found to be significantly decreased when the thyroiditis was present (q = –2.378; p < 0.05). Conclusions The increased levels of serum IL-6, IL-15, IL-17A and IFNγ in children suggest imbalance in the serum proinflammatory cytokines production in AA.
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Ebrahim AA, Salem RM, El Fallah AA, Younis ET. Serum Interleukin-15 is a Marker of Alopecia Areata Severity. Int J Trichology 2019; 11:26-30. [PMID: 30820130 PMCID: PMC6385510 DOI: 10.4103/ijt.ijt_80_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Interleukin-15 (IL-15) is a cytokine that is involved in many inflammatory and autoimmune diseases. Although alopecia areata (AA) is an autoimmune disease, serum levels of IL-15 have not been studied well in AA patients. Aim of the Work: We aims at evaluating the serum levels of IL-15 in active AA. Subject and Methods: This case-control study included 40 AA patients and 40 apparently healthy matched controls. Written informed consents were obtained from all the participants. The scalp was examined to assess sites, number, and size of alopecia patches, and the severity of AA lesions was assessed using the Severity of Alopecia Tool score (SALT score) which determine the percentage of hair loss in the scalp. The body was carefully examined to detect any alopecia patches in any hairy area. Nail examination was carried out to detect any nail involvement. Serum IL-15 levels were measured using an ELISA kits. Results: Serum levels of IL-15 in patients were significantly higher than those in the control group (P < 0.001). Serum levels in alopecia totalis were significantly higher than those with one or two patches, and serum levels in patients with both scalp and body involvement were significantly elevated than the levels of patients with either scalp or body involvement. There was a statistically significant positive correlation between SALT score and serum levels of IL-15 (P < 0.001). Conclusion: Serum IL-15 may be a marker of AA severity.
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Affiliation(s)
- Adel Ali Ebrahim
- Department of Dermatology, Faculty of Medicine, Benha University, Qalubia, Egypt
| | - Rehab Mohammed Salem
- Department of Dermatology, Faculty of Medicine, Benha University, Qalubia, Egypt
| | - Asmaa Adel El Fallah
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Qalubia, Egypt
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16
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Gong Y, Zhao Y, Zhang X, Qi S, Li S, Ye Y, Yang J, Caulloo S, McElwee KJ, Zhang X. Serum level of
IL
‐4 predicts response to topical immunotherapy with diphenylcyclopropenone in alopecia areata. Exp Dermatol 2018; 29:231-238. [DOI: 10.1111/exd.13758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/08/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Yugang Gong
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
- Institute of Dermatology and VenereologySichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital Chengdu China
| | - Ying Zhao
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Xiaoting Zhang
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Shiling Qi
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Shuifeng Li
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Yanting Ye
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Jian Yang
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Sillani Caulloo
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | | | - Xingqi Zhang
- Department of DermatologyThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
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17
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Morsy H, Maher R, Negm D. Correlation between serum IL-17A level and SALT score in patients with alopecia areata before and after NB-UVB therapy. J Cosmet Dermatol 2018; 17:533-537. [DOI: 10.1111/jocd.12664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Hanan Morsy
- Department of Dermatology, Venereology and Andrology; Faculty of Medicine; Assiut University; Assiut Egypt
| | - Reham Maher
- Department of Dermatology, Venereology and Andrology; Faculty of Medicine; Assiut University; Assiut Egypt
| | - Dalia Negm
- Department of Clinical Pathology; Faculty of Medicine; Assiut University; Assiut Egypt
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18
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Abstract
CD4+ Foxp3+ regulatory T cells (Tregs) are suppressors of immune activation and play a crucial role in the maintenance of peripheral tolerance. Mutations of Foxp3 result in fatal autoimmunity in multiple organs, including the skin, in both humans and mice. Many studies have demonstrated the altered frequency and functions of Tregs, changes in cytokine and chemokine levels related to Tregs and the differences in genetic background regarding Tregs in autoimmune skin disorders. Recent studies have extended our knowledge of certain properties of Tregs, especially skin-resident Tregs. In addition, some novel therapies have been performed by modulating the number and the function of Tregs. This review focuses on the role of Tregs in some autoimmune skin disorders, including alopecia areata, vitiligo, pemphigoid and pemphigus, and systemic sclerosis, and discusses questions that remain to be addressed.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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19
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Czarnowicki T, He HY, Wen HC, Hashim PW, Nia JK, Malik K, Estrada Y, Kimmel GW, Taliercio M, Krueger JG, Guttman-Yassky E. Alopecia areata is characterized by expansion of circulating Th2/Tc2/Th22, within the skin-homing and systemic T-cell populations. Allergy 2018; 73:713-723. [PMID: 29083474 DOI: 10.1111/all.13346] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Characterizing blood profile of alopecia areata (AA) is important not only for treatment advancements, but also for possibly identifying peripheral biomarkers that will eliminate the need for scalp biopsies. We aimed to compare frequencies of skin homing (CLA+ ) vs systemic (CLA- ) "polar" CD4+ and CD8+ and activated T-cell subsets in AA vs atopic dermatitis (AD) and control blood. METHODS Flow cytometry was used to measure IFN-γ, IL-13, IL-9, IL-17, and IL-22 cytokines in CD4+ and CD8+ T cells. Inducible co-stimulator molecule (ICOS) and HLA-DR were used to define mid- and long-term T-cell activation. We compared peripheral blood from 32 moderate-to-severe AA adults with 43 moderate-to-severe AD patients and 30 age-matched controls. RESULTS AA patients had increased CLA+ /CLA- Th2 (P < .007), CLA+ Tc2 (P = .04), and CLA+ Th22 (P < .05) frequencies than controls. Except of CLA- Tc1 cells (P = .03), IFN-γ levels were mostly similar between AA, AD, and controls (P > .1). ICOS and HLA-DR activation were significantly higher in AA than controls (P < .05). T regulatory cells were significantly decreased in AA patients than controls (P < .01) and were correlated with activated CD8+ T cells and with multiple cytokine subsets (P < .05). While Th2 and Tc2 clustered with disease severity, IFN-γ producing cells were linked with AA duration. CONCLUSIONS Alopecia areata is accompanied by Th2/Tc2 activation in skin-homing and systemic subsets, correlating with disease severity, while IFN-γ is linked to disease chronicity. These data hint for a possible role of diverse T-cells subsets in disease pathogenesis and emphasize the systemic nature of AA supporting the need for systemic therapeutic strategies in severe patients.
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Affiliation(s)
- T. Czarnowicki
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - H. Y. He
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - H.-C. Wen
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - P. W. Hashim
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - J. K. Nia
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - K. Malik
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
- SUNY Downstate College of Medicine; Brooklyn NY USA
| | - Y. Estrada
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - G. W. Kimmel
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Taliercio
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - J. G. Krueger
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - E. Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
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20
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Lee SH, Moon JH, Ban DH, Byun JW, Shin J, Choi GS. Can the Cytokine Analysis of the Scales on Alopecic Patch Predict the Response to Diphenylcyclopropenone Treatment in Alopecia Areata Patients? Ann Dermatol 2018; 30:150-157. [PMID: 29606811 PMCID: PMC5839885 DOI: 10.5021/ad.2018.30.2.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022] Open
Abstract
Background Contact immune modulating therapy with diphenylcyclopropenone (DPCP) is a topical treatment option for extensive alopecia areata (AA). Because the response to DPCP treatment varies according to the patient, and it takes several months to evaluate the clinical effectiveness of the treatment, it is necessary to identify the factors that can predict the prognosis of the disease while treating with topical DPCP. Objective In this study, cytokine levels in the scales of alopecic patches were investigated to identify whether they could predict response to DPCP during the early treatment period. Methods Scale samples were taken from the alopecic patches in eight AA patients at 1 week, 2 months, and 4 months after DPCP sensitization. The patients were divided into responders and non-responders according to the clinical responses of DPCP treatment. Interferon (IFN)-gamma, interleukin (IL)-2, IL-12 and IL-10 levels of the subjects were compared in several perspectives. Results Cytokine levels after 1 week of DPCP sensitization showed no statistically significant difference between two groups. After 4 months of treatment, IFN-gamma levels were significantly lower in responders than in non-responders. Conclusion The results of this study show IFN-gamma levels in the scales of alopecic patches might possibly reflect the clinical response in AA patients treated with DPCP. However, initial cytokine levels could not predict the treatment response.
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Affiliation(s)
- Si Hyub Lee
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Jong Hyuk Moon
- Department of Dermatology, Naval Pohang Hospital, Pohang, Korea
| | | | - Ji Won Byun
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Jeonghyun Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
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21
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Kasumagić-Halilovic E, Cavaljuga S, Ovcina-Kurtovic N, Zecevic L. Serum Levels of Interleukin-2 in Patients with Alopecia Areata: Relationship with Clinical Type and Duration of the Disease. Skin Appendage Disord 2018; 4:286-290. [PMID: 30410898 DOI: 10.1159/000486462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background Alopecia areata (AA) is a disease characterized by focally, nonscarring hair loss on the scalp or any hair-bearing surface. The etiology is unknown, although the evidence suggests that AA is an immunologically mediated disease. In the pathogenesis of AA, Th1 immune response is predominant. A special cytokine profile is created by Th1 cells, which disturbs the natural balance of the cytokine networks and leads to inflammatory reaction and follicle damage. Objective The aim of our study was to evaluate serum concentrations of IL-2 in patients with AA and healthy subjects. We also examined a possible association between serum levels of IL-2, disease severity, and duration of AA. Methods Sixty patients with AA and 20 healthy controls were enrolled in the study. Serum concentrations of IL-2 were measured using enzyme-linked immunoassay techniques. Results Comparison of mean values of IL-2 has showed that serum concentrations of this cytokine are significantly higher in serum samples of AA patients in relation to the control group (22.2 ± 1.19 vs. 21.1 ± 2.68 pg/mL, respectively; p = 0.0142). No correlations were found between clinical type, duration of the disease, and serum levels of IL-2. Conclusion Our findings support the evidence that elevation of serum IL-2 is associated with AA. The exact role of serum IL-2 in AA should be additionally investigated in future studies.
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Affiliation(s)
- Emina Kasumagić-Halilovic
- Department of Dermatovenereology, Clinical Centre of Sarajevo University, Sarajevo, Bosnia-Herzegovina
| | - Semra Cavaljuga
- Institute of Epidemiology and Biostatistics, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia-Herzegovina
| | - Nermina Ovcina-Kurtovic
- Department of Dermatovenereology, Clinical Centre of Sarajevo University, Sarajevo, Bosnia-Herzegovina
| | - Lamija Zecevic
- Institute of Clinical Immunology, Clinical Centre Sarajevo, Sarajevo, Bosnia-Herzegovina
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22
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Loh SH, Moon HN, Lew BL, Sim WY. Role of T helper 17 cells and T regulatory cells in alopecia areata: comparison of lesion and serum cytokine between controls and patients. J Eur Acad Dermatol Venereol 2018; 32:1028-1033. [PMID: 29283462 DOI: 10.1111/jdv.14775] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/05/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an organ-specific autoimmune disease with T-cell-mediated attack of hair follicle autoantigens. As T helper 17 (Th17) cells and T regulatory (Treg) cells are crucially involved in the pathogenesis, the role of Th17 and Treg cytokines has not been studied yet. OBJECTIVE To determine whether AA is associated with alterations in lesional and serum Th17 and Treg cytokines and studied whether they were associated with clinical type. METHODS Scalp skin samples from 45 patients and eight normal controls were obtained for PCR specific for IFN-γ, TNF-α, TGF-β, IL-1, IL-2, IL-4, IL-10, IL-12A, IL-13, IL-17, IL-22 and IL-23. Serum cytokines were measured from 55 patients and 15 normal controls using ELISA. RESULTS Lesional IL-17 and IL-22 were significantly increased in patient group. Moreover, positive correlations were shown between lesional IL-17, IL-22 and disease severity. Serum IL-1, IL-17, TNF-α and TGF-β were significantly increased, and positive correlation was shown between serum IL-17 and disease severity. CONCLUSION These results showed significantly high Th17 cytokines in both lesion and serum in AA patients, which may highlight a functional role of these cytokines in the pathogenesis of AA.
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Affiliation(s)
- S-H Loh
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - H-N Moon
- Department of Biochemical Science, Graduate School, Kyung Hee University, Seoul, Korea
| | - B-L Lew
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - W-Y Sim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
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23
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Ghaffari J, Rokni GR, Kazeminejad A, Abedi H. Association among Thyroid Dysfunction, Asthma, Allergic Rhinitis and Eczema in Children with Alopecia Areata. Open Access Maced J Med Sci 2017; 5:305-309. [PMID: 28698747 PMCID: PMC5503727 DOI: 10.3889/oamjms.2017.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/29/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Alopecia areata is a non-scarring hair loss, which typically starts quickly. Atopy is one of the possible predisposing risk factors for this condition. AIM This study aimed to evaluate the prevalence of thyroid disease, atopic dermatitis and allergic diseases in children with alopecia areata and compare the results with healthy individuals. METHODS This case-control study was conducted on 50 patients with alopecia areata, diagnosed by a dermatologist, and 150 healthy individuals as the control group. Participants filled the questionnaires, and necessary tests were performed. RESULTS In this study, the mean age of the participants was 2.55 ± 14.26 and 3.19 ± 11.92 in the case and control groups, respectively. Prevalence of asthma was 22% in the case group and 12.5% in control group (P = 0.109). Also, allergic rhinitis and eczema were observed in 20% and 22% of the subjects of the case group, whereas they were reported to be 8% and 10% in the control group (PV = 0.03 and 0.175, respectively). Moreover, 28% and 8% of the participants in the case and control groups had a family history of atopy and allergic disorders, respectively (P = 0.046). A significant difference was observed between the two groups regarding gender, type of delivery and contact with animals. CONCLUSIONS According to the results of this study, a significant association was observed between the prevalence of alopecia areata and atopic conditions, such as allergic rhinitis and history of atopic dermatitis.
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Affiliation(s)
- Javad Ghaffari
- Infectious Disease Research Center with Focus on Nosocomial Infection, Bou-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Hosein Abedi
- Mazandaran University of Medical Sciences, Sari, Iran
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24
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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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25
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Gohary YM, Abdel Fattah DS. Detection of Tumor Necrosis Factor-alpha in Nonlesional Tissues of Alopecia Areata Patients: A Prove for a Systemic Disease. Int J Trichology 2017; 9:154-159. [PMID: 29118519 PMCID: PMC5655623 DOI: 10.4103/ijt.ijt_47_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The pathogenesis of alopecia areata (AA) remains incompletely understood. Different cytokines may play a role in AA. Tumor necrosis factor-alpha (TNF-α) has been shown to be inhibitory to hair follicle growth in in vitro studies suggesting that it may play an important role in AA. This study was conducted to assess the presence of TNF-α in lesional and nonlesional skin of AA, to review its possible role in AA, and to show whether AA is a systemic or localized disease by comparing the level of TNF-α between lesional and nonlesional skin biopsies of the patients. Materials and Methods Thirty patients with AA and thirty age- and sex-matched healthy controls were included in the study. A 4 mm punch skin biopsy was taken from lesional and nonlesional skin of every patient, as well as from the normal skin of each individual in the control group for immunohistochemical analysis of TNF-α. Results The level of TNF-α in lesional skin biopsies was significantly higher than in nonlesional skin biopsies of patients as well as controls' biopsies. Furthermore, TNF-α level in nonlesional biopsies of patients was significantly higher than the level in controls' biopsies. Conclusions We concluded that skin of AA has a high level of TNF-α (a normal inhibitor of hair follicle growth in vitro). This high level may point to the important role of TNF-α in AA. Further studies should be conducted to detect the level of TNF-α in long-standing AA and the more severe cases of AA.
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Affiliation(s)
- Yasser Mostsfa Gohary
- Department of Dermatology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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26
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Dainichi T, Kabashima K. Alopecia areata: What's new in epidemiology, pathogenesis, diagnosis, and therapeutic options? J Dermatol Sci 2016; 86:3-12. [PMID: 27765435 DOI: 10.1016/j.jdermsci.2016.10.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 12/12/2022]
Abstract
Alopecia areata (AA) is a common and stressful disorder that results in hair loss, and resistant to treatment in some cases. Experimental and clinical evidence suggests that AA is caused by autoimmune attack against the hair follicles. The precise pathomechanism, however, remains unknown. Here, we focus on the recent progress in multidisciplinary approaches to the epidemiology, pathogenesis, and new treatments of AA in 996 publications from January 2010 to July 2016, and provide an overview of the current understanding in clinical management and research directions.
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Affiliation(s)
- Teruki Dainichi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Singapore Immunology Network (SIgN) and Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore; PRESTO, Japan Science and Technology Agency, Kawaguchi, Japan
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27
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Atwa MA, Youssef N, Bayoumy NM. T-helper 17 cytokines (interleukins 17, 21, 22, and 6, and tumor necrosis factor-α) in patients with alopecia areata: association with clinical type and severity. Int J Dermatol 2016; 55:666-72. [PMID: 26235375 DOI: 10.1111/ijd.12808] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/30/2014] [Accepted: 07/07/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an organ-specific autoimmune disease characterized by T-cell infiltrates and cytokine production. T-helper 17 (Th17) cells are crucially involved in the pathogenesis of autoimmune diseases. OBJECTIVES Our aim was to assess the association of Th17 with AA. We examined interleukin (IL)-17, IL-21, IL-22, IL-6, and tumor necrosis factor-alpha (TNF-α) levels in the serum of patients with AA and studied their association with clinical type and severity of AA. SUBJECTS AND METHODS The serum concentrations of IL-17, IL-21, IL-22, IL-6, and TNF-α were measured in 47 patients with AA and 40 healthy controls. The clinical type of AA was determined, and the severity of hair loss was assessed in accordance with the Alopecia Areata Investigational Assessment Guideline criteria. RESULTS The serum concentrations of IL-17, IL-21, IL-22, IL-6, and TNF-α were significantly higher in patients with AA as compared with healthy controls (mean: IL-17 33.23 ± 11.58 vs. 4.62 ± 1.88 pg/ml; P = 0.000, IL-21 62.10 ± 6.11 vs. 48.38 ± 3.31 pg/ml; P = 0.000, IL-22 19.27 ± 3.36 vs. 7.09 ± 1.62 pg/ml; P = 0.000, IL-6 17.18 ± 3.08 vs. 4.59 ± 1.66 pg/ml; P = 0.000, TNF-α 19.94 ± 3.59 vs. 9.95 ± 2.42 pg/ml; P = 0.000, respectively). There were significant positive correlations between serum IL-17, TNF-α, and disease severity. There was also significant positive correlation between serum IL-22 and duration of AA. CONCLUSION Our results showed high serum levels of Th17 cytokines among patients with AA that may suggest a functional role of these cytokines in the pathogenesis of this important skin disease. It could also provide the rationale for new treatment strategies in AA.
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Affiliation(s)
- Mona A Atwa
- Department of Dermatology and Venereology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nahed Youssef
- Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nervana M Bayoumy
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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El-Morsy EH, Eid AA, Ghoneim H, Al-Tameemi KA. Serum level of interleukin-17A in patients with alopecia areata and its relationship to age. Int J Dermatol 2015; 55:869-74. [PMID: 26475394 DOI: 10.1111/ijd.12994] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/27/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is strong evidence for an autoimmune etiology of alopecia areata (AA). Interleukin-17A (IL-17A) is a Th17 proinflammatory cytokine that has been linked to the pathogeneses of diverse autoimmune and inflammatory diseases. OBJECTIVES This study aimed to measure serum IL-17A in AA patients and to study associations between IL-17A levels and AA severity, duration, and age of onset, and patient gender and age. METHODS The study enrolled 39 AA patients and 37 healthy control subjects. Scalp involvement was assessed using the Severity of Alopecia Tool (SALT), and clinical disease severity was determined. Serum IL-17A was measured using ELISAs. RESULTS Serum IL-17A was significantly higher in AA patients than in control subjects (P < 0.001). Correlations between serum IL-17A and gender, disease duration, SALT score, and disease severity were non-significant. Serum IL-17A was significantly higher in patients aged ≤30 years than in patients aged >30 years (P = 0.045). Age and serum IL-17A were significantly negatively correlated in patients with AA (rs = -0.363, P = 0.023) but not in control subjects (rs = -0.294, P = 0.077). Patients with juvenile-onset AA had significantly higher IL-17A levels than those with maturity-onset disease (P = 0.034). There was a significant negative correlation between age at disease onset and serum IL-17A (rs = -0.349, P = 0.029). CONCLUSIONS It is possible that IL-17A plays a role in the pathogenesis of AA. Serum IL-17A may be influenced by patient age and age of onset of AA but does not seem to influence disease severity.
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Affiliation(s)
- Eman H El-Morsy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amira A Eid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hossam Ghoneim
- Department of Immunology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Khaleel A Al-Tameemi
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Bilgic O, Sivrikaya A, Unlu A, Altinyazar HC. Serum cytokine and chemokine profiles in patients with alopecia areata. J DERMATOL TREAT 2015; 27:260-3. [DOI: 10.3109/09546634.2015.1093591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Suárez-Fariñas M, Ungar B, Noda S, Shroff A, Mansouri Y, Fuentes-Duculan J, Czernik A, Zheng X, Estrada YD, Xu H, Peng X, Shemer A, Krueger JG, Lebwohl MG, Guttman-Yassky E. Alopecia areata profiling shows TH1, TH2, and IL-23 cytokine activation without parallel TH17/TH22 skewing. J Allergy Clin Immunol 2015; 136:1277-87. [PMID: 26316095 DOI: 10.1016/j.jaci.2015.06.032] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a common T cell-mediated disorder with limited therapeutics. A molecular profile of cytokine pathways in AA tissues is lacking. Although studies have focused on TH1/IFN-γ responses, several observations support a shared genetic background between AA and atopy. OBJECTIVE We sought to define the AA scalp transcriptome and associated biomarkers with comparisons with atopic dermatitis (AD) and psoriasis. METHODS We performed microarray and RT-PCR profiling of 27 lesional and 17 nonlesional scalp samples from patients with AA for comparison with normal scalp samples (n = 6). AA gene expression was also compared with samples from patients with lesional or nonlesional AD and those with psoriasis. A fold change of greater than 1.5 and a false discovery rate of less than 0.05 were used for differentially expressed genes (DEGs). RESULTS We established the AA transcriptomes (lesional vs nonlesional: 734 DEGs [297 upregulated and 437 downregulated]; lesional vs normal: 4230 DEGs [1980 upregulated and 2250 downregulated]), including many upregulated immune and downregulated hair keratin genes. Equally impressive as upregulation in TH1/interferon markers (IFNG and CXCL10/CXCL9) were those noted in TH2 (IL13, CCL18, CCL26, thymic stromal lymphopoietin, and periostin), TH9/IL-9, IL-23 (p40 and p19), and IL-16 mediators (all P < .05). There were no increases in TH17/TH22 markers. Hair keratin (KRT) expressions (ie, KRT86 and KRT85) were significantly suppressed in lesional skin. Greater scalp involvement (>25%) was associated with greater immune and keratin dysregulation and larger abnormalities in nonlesional scalp samples (ie, CXCL10 and KRT85). CONCLUSIONS Our data associate the AA signature with TH2, TH1, IL-23, and IL-9/TH9 cytokine activation, suggesting consideration of anti-TH2, anti-TH1, and anti-IL-23 targeting strategies. Similar to psoriasis and AD, clinical trials with selective antagonists are required to dissect key pathogenic pathways.
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Affiliation(s)
- Mayte Suárez-Fariñas
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Genetics and Genomics Science, Icahn School of Medicine at Mount Sinai, New York, NY; Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Shinji Noda
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Anjali Shroff
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yasaman Mansouri
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Annette Czernik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Xiuzhong Zheng
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Yeriel D Estrada
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hui Xu
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Xiangyu Peng
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Avner Shemer
- Department of Dermatology, Tel-Hashomer, Tel Aviv, Israel
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Genetics and Genomics Science, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY; Department of Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Li Y, Yan B, Wang H, Li H, Li Q, Zhao D, Chen Y, Zhang Y, Li W, Zhang J, Wang S, Shen J, Li Y, Guindi E, Zhao Y. Hair regrowth in alopecia areata patients following Stem Cell Educator therapy. BMC Med 2015; 13:87. [PMID: 25896390 PMCID: PMC4417286 DOI: 10.1186/s12916-015-0331-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/17/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Alopecia areata (AA) is one of the most common autoimmune diseases and targets the hair follicles, with high impact on the quality of life and self-esteem of patients due to hair loss. Clinical management and outcomes are challenged by current limited immunosuppressive and immunomodulating regimens. METHODS We have developed a Stem Cell Educator therapy in which a patient's blood is circulated through a closed-loop system that separates mononuclear cells from the whole blood, allows the cells to briefly interact with adherent human cord blood-derived multipotent stem cells (CB-SC), and returns the "educated" autologous cells to the patient's circulation. In an open-label, phase 1/phase 2 study, patients (N = 9) with severe AA received one treatment with the Stem Cell Educator therapy. The median age was 20 years (median alopecic duration, 5 years). RESULTS Clinical data demonstrated that patients with severe AA achieved improved hair regrowth and quality of life after receiving Stem Cell Educator therapy. Flow cytometry revealed the up-regulation of Th2 cytokines and restoration of balancing Th1/Th2/Th3 cytokine production in the peripheral blood of AA subjects. Immunohistochemistry indicated the formation of a "ring of transforming growth factor beta 1 (TGF-β1)" around the hair follicles, leading to the restoration of immune privilege of hair follicles and the protection of newly generated hair follicles against autoimmune destruction. Mechanistic studies revealed that co-culture with CB-SC may up-regulate the expression of coinhibitory molecules B and T lymphocyte attenuator (BTLA) and programmed death-1 receptor (PD-1) on CD8β(+)NKG2D(+) effector T cells and suppress their proliferation via herpesvirus entry mediator (HVEM) ligands and programmed death-1 ligand (PD-L1) on CB-SCs. CONCLUSIONS Current clinical data demonstrated the safety and efficacy of the Stem Cell Educator therapy for the treatment of AA. This innovative approach produced lasting improvement in hair regrowth in subjects with moderate or severe AA. TRIAL REGISTRATION ClinicalTrials.gov, NCT01673789, 21 August 2012.
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Affiliation(s)
- Yanjia Li
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Baoyong Yan
- Cell Therapy Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Hepeng Wang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Heng Li
- Department of Neurology, Jinan Central Hospital, Shandong University, Jinan, Shandong, 250013, P.R. China.
| | - Quanhai Li
- Cell Therapy Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Dong Zhao
- Department of Pathology, Jinan Central Hospital, Shandong University, Jinan, Shandong, 250013, P.R. China.
| | - Yana Chen
- Department of Obstetrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, 250013, P.R. China.
| | - Ye Zhang
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Wenxia Li
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Jun Zhang
- Cell Therapy Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050031, P.R. China.
| | - Shanfeng Wang
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Jie Shen
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | - Yunxiang Li
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China.
| | | | - Yong Zhao
- Tianhe Stem Cell Biotechnologies Inc., Jinan, Shandong, 250055, P.R. China. .,Department of Research, Hackensack University Medical Center, 40 Prospect Avenue, Hackensack, NJ, 07601, USA.
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Yenin JZ, Serarslan G, Yönden Z, Ulutaş KT. Investigation of oxidative stress in patients with alopecia areata and its relationship with disease severity, duration, recurrence and pattern. Clin Exp Dermatol 2014; 40:617-21. [PMID: 25524272 DOI: 10.1111/ced.12556] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an inflammatory autoimmune disease that causes hair loss on the scalp or trunk without scarring. Although the precise aetiopathogenesis of alopecia areata remains unknown, oxidative stress is thought to play a role. AIM To investigate the relationship between severity and the role of oxidative stress in AA, by measuring plasma oxidant levels and antioxidant enzyme activities in erythrocytes. METHODS In total, 62 patients with AA (24 males and 38 females), and 62 sex- and age-matched healthy controls (HCs) were enrolled in the study. We investigated the levels of plasma malondialdehyde (MDA) and the activities of erythrocyte catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). The relationship between oxidative stress and AA was also investigated with regard to disease pattern, severity, duration and recurrence. RESULTS The mean erythrocyte GSH-Px and SOD activities were significantly reduced (P < 0.001 and P < 0.001 respectively) compared with the control group. Plasma MDA levels were increased but statistically insignificant (P = 0.08) in patients with AA compared with controls. No significant difference between erythrocyte CAT activities was observed between patients and controls (P = 0.2). In addition, we observed no statistically significant difference in patient plasma MDA levels or erythrocyte CAT, GSH-Px or SOD activities with regard to AA severity, duration, recurrence or pattern (P > 0.05). CONCLUSIONS Patients with AA displayed reduced erythrocyte SOD and GSH-Px activities and enhanced plasma MDA levels. These findings support the possible role of oxidative stress in the pathogenesis of AA.
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Affiliation(s)
- J Z Yenin
- Department of Dermatology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - G Serarslan
- Department of Dermatology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Z Yönden
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - K T Ulutaş
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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Ito T, Tokura Y. The role of cytokines and chemokines in the T-cell-mediated autoimmune process in alopecia areata. Exp Dermatol 2014; 23:787-91. [DOI: 10.1111/exd.12489] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Taisuke Ito
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
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Li SF, Zhang XT, Qi SL, Ye YT, Cao H, Yang YQ, McElwee KJ, Zhang X. Allergy to dust mites may contribute to early onset and severity of alopecia areata. Clin Exp Dermatol 2014; 40:171-6. [PMID: 25252126 DOI: 10.1111/ced.12471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND A higher risk of allergic diseases such as rhinitis, asthma and atopic eczema (atopic dermatitis) has been reported for patients with alopecia areata (AA) compared with the general population, but the significance of this is still largely unclear. AIM To determine whether serum total or specific IgE play a role in the onset and severity of AA. METHODS We tested 461 serum samples from 351 patients with AA and 110 healthy controls (HC) for total IgE (tIgE) and specific IgE (sIgE) by ImmunoCAP-100 or in vitro test (IVT). RESULTS The absolute value of tIgE was higher in patients with AA than in normal controls (P < 0.001), although the prevalence of raised tIgE (> 120 IU/mL) detected in patients with AA (29.3%) was similar to that of HC (21.8%). Prevalences of raised sIgE against various allergens detected by ImmunoCAP-100 showed that Dermatophagoides pteronyssinus (Der p; 31.1%) and Dermatophagoides farinae (Der f; 29.0%) were the most common allergens. Similar results were found by IVT, with the most common response being against Der p/Der f (29.0%). However, the prevalences of tIgE and sIgE against dust mites (Der p and Der f) in patients with early-onset AA and severe AA were significantly higher than those with late-onset AA and mild AA (P = 0.02, P = 0.02 vs. P = 0.03 and P = 0.001, respectively). Notably, the increases in tIgE and sIgE were independent of atopy history. CONCLUSIONS Allergy to dust mites may have an effect on the immune response in AA, and may contribute to its early onset and severity in patients of Chinese origin.
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Affiliation(s)
- S F Li
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Ovcharenko Y, Serbina I, Zlotogorski A, Ramot Y. Renbök phenomenon in an alopecia areata patient with psoriasis. Int J Trichology 2014; 5:194-5. [PMID: 24778529 PMCID: PMC3999649 DOI: 10.4103/0974-7753.130397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Renbök phenomenon designates the withdrawal of a lesion when a different one appears. We describe a 23-year-old patient with psoriasis, who experienced regression of a psoriatic plaque on the scalp concurrently with the appearance of a patch of alopecia areata (AA). In 3 months, plaques of psoriasis appeared inside the patch of hair loss, accompanied by terminal hair growth in the plaques. Such rapid interchange between these two autoimmune disorders have not been described previously, and might reflect a quick substitution between two different T-cell populations, namely Th-17 and Th-1. Better understanding of the trigger for such an exchange can help in elucidating the pathogenesis for AA.
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Affiliation(s)
- Yuliya Ovcharenko
- Department of Dermatovenereology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
| | - Inessa Serbina
- Department of Dermatovenereology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yuval Ramot
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Inui S, Noguchi F, Nakajima T, Itami S. Serum thymus and activation-regulated chemokine as disease activity and response biomarker in alopecia areata. J Dermatol 2013; 40:881-5. [DOI: 10.1111/1346-8138.12273] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/28/2013] [Indexed: 01/14/2023]
Affiliation(s)
- Shigeki Inui
- Department of Regenerative Dermatology; Osaka University Graduate School of Medicine; Suita Japan
| | - Fumihito Noguchi
- Department of Regenerative Dermatology; Osaka University Graduate School of Medicine; Suita Japan
| | - Takeshi Nakajima
- Department of Regenerative Dermatology; Osaka University Graduate School of Medicine; Suita Japan
| | - Satoshi Itami
- Department of Regenerative Dermatology; Osaka University Graduate School of Medicine; Suita Japan
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Tembhre M, Sharma V. T-helper and regulatory T-cell cytokines in the peripheral blood of patients with active alopecia areata. Br J Dermatol 2013; 169:543-8. [DOI: 10.1111/bjd.12396] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/22/2022]
Affiliation(s)
- M.K. Tembhre
- Department of Dermatology and Venereology; All India Institute of Medical Sciences; Ansari Nagar; New Delhi; 110029; India
| | - V.K. Sharma
- Department of Dermatology and Venereology; All India Institute of Medical Sciences; Ansari Nagar; New Delhi; 110029; India
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Alfadhli S, Nanda A. Genetic analysis of interleukin-1 receptor antagonist and interleukin-1β single-nucleotide polymorphisms C-511T and C+3953T in alopecia areata: susceptibility and severity association. Clin Exp Med 2013; 14:197-202. [PMID: 23584371 DOI: 10.1007/s10238-013-0228-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/29/2013] [Indexed: 01/08/2023]
Abstract
The present study was aimed to explore the effect of two selected polymorphisms from interleukin-1β (IL-1β) gene [SNPs -511 and +3953] and a variable number of tandem repeat (VNTR) from interleukin-1 receptor antagonist (IL-1RN) on the susceptibility and severity of alopecia areata (AA) in Kuwaiti subjects. IL-1β SNPs C-511T, C+3953T, and IL-1RN VNTR were screened in 96 alopecia patients classified clinically, according to the disease severity as patchy (P), semiuniversalis (SU), and universalis (U), and in 100 ethnically matched healthy controls. Polymerase chain reaction followed by restriction fragment length polymorphism and direct DNA sequencing were employed for genotyping. Comparing the stratified AA cases based on severity, IL-β SNP C-511T showed a significant association (genotype and allelotype levels p = 0.03 and p = 0.028, respectively). Genotype CC was 50 % more frequent in U cases than in P or SU. When P and SU were grouped and tested against U, a significant difference was observed (genotype and allelotype levels p = 0.006 and p = 0.008, respectively). Compared to genotype CT, carriers of IL-1β -511 CC genotype showed an increased risk to develop severe AA (p = 0.004, OR = 4.14, 95 % CI = 1.61-10.69). Four alleles and genotypes (1/1, 1/3, 1/4, and 2/2) of IL-1RN VNTR were detected in AA patients while only two (1/1 and 1/3) in controls. IL-1RN VNTR showed genotype and allelotype association with AA (p = 0.05 and p = 0.025, respectively). Our results showed that IL-1β and IL-1RN VNTR are significantly associated with the susceptibility to alopecia areata. Allele C of the IL-β C-511T SNP is linked to the severe form of AA.
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Affiliation(s)
- Suad Alfadhli
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, PO Box 31470, Sulaibekhat, Kuwait, Kuwait,
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Duncan FJ, Silva KA, Johnson C, King B, Szatkiewicz JP, Kamdar S, Ong DE, Napoli JL, Wang J, King LE, Whiting DA, McElwee KJ, Sundberg JP, Everts HB. Endogenous retinoids in the pathogenesis of alopecia areata. J Invest Dermatol 2013; 133:334-43. [PMID: 23014334 PMCID: PMC3546144 DOI: 10.1038/jid.2012.344] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Alopecia areata (AA) is an autoimmune disease that attacks anagen hair follicles. Gene array in graft-induced C3H/HeJ mice revealed that genes involved in retinoic acid (RA) synthesis were increased, whereas RA degradation genes were decreased in AA compared with sham controls. This was confirmed by immunohistochemistry in biopsies from patients with AA and both mouse and rat AA models. RA levels were also increased in C3H/HeJ mice with AA. C3H/HeJ mice were fed a purified diet containing one of the four levels of dietary vitamin A or an unpurified diet 2 weeks before grafting and disease progression followed. High vitamin A accelerated AA, whereas mice that were not fed vitamin A had more severe disease by the end of the study. More hair follicles were in anagen in mice fed high vitamin A. Both the number and localization of granzyme B-positive cells were altered by vitamin A. IFNγ was also the lowest and IL13 highest in mice fed high vitamin A. Other cytokines were reduced and chemokines increased as the disease progressed, but no additional effects of vitamin A were seen. Combined, these results suggest that vitamin A regulates both the hair cycle and immune response to alter the progression of AA.
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Affiliation(s)
- F. Jason Duncan
- Department of Nutrition, The Ohio State University, Columbus, OH
| | | | - Charles Johnson
- Department of Nutrition, The Ohio State University, Columbus, OH
| | | | | | | | - David E. Ong
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - John P. Sundberg
- The Jackson Laboratory, Bar Harbor, ME
- Vanderbilt University Medical Center, Nashville, TN
| | - Helen B. Everts
- Department of Nutrition, The Ohio State University, Columbus, OH
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Rudnicka L, Lukomska M. Alternaria scalp infection in a patient with alopecia areata. Coexistence or causative relationship? J Dermatol Case Rep 2013; 6:120-4. [PMID: 23329992 DOI: 10.3315/jdcr.2012.1120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/26/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Alopecia areata is an autoimmune disease that is affecting anagen hair follicles. The triggers of autoimmunity in patients with alopecia areata remain unknown. MAIN OBSERVATION A 13-year-old boy developed multiple hairless patches of focal hair loss with typical clinical and trichoscopy features of alopecia areata. Mycology examination of the scalp hair and epidermal scrapings reveled massive growth of Alternaria chlamydospora. CONCLUSION We hypothesize that fungal antigens (e.g. antigens involved in fungal melanin synthesis) may be possible triggers, contributing to autoimmune reactions in patients with alopecia areata. We discuss research data, which may indirectly support this hypothesis, however the concept has yet to be verified.
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Affiliation(s)
- Lidia Rudnicka
- Department of Dermatology CSK MSW, Warsaw, Poland ; Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland ; Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
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Tanemura A, Oiso N, Nakano M, Itoi S, Kawada A, Katayama I. Alopecia Areata: Infiltration of Th17 Cells in the Dermis, Particularly around Hair Follicles. Dermatology 2013; 226:333-6. [DOI: 10.1159/000350933] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/18/2013] [Indexed: 11/19/2022] Open
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Jabbari A, Petukhova L, Cabral RM, Clynes R, Christiano AM. Genetic basis of alopecia areata: a roadmap for translational research. Dermatol Clin 2012; 31:109-17. [PMID: 23159180 DOI: 10.1016/j.det.2012.08.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alopecia areata (AA) is a recurrent autoimmune type of hair loss that affects about 5.3 million people in the United States alone. Despite being the most prevalent autoimmune disease, the molecular and cellular mechanisms underlying this complex disease are still poorly understood, and rational treatments are lacking. Further efforts are necessary to clearly pinpoint the causes and molecular pathways leading to this disease and to find evidence-based treatments for AA. The authors focus on the central role of genetics for gaining insight into disease pathogenesis and setting the stage for the rational development of novel effective therapeutic approaches.
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Affiliation(s)
- Ali Jabbari
- Department of Dermatology, Russ Berrie Medical Science Pavilion, Columbia University, 1150 Saint Nicholas Avenue, New York, NY 10032, USA
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Słowińska M, Kardynal A, Warszawik O, Czuwara J, Rudnicka L. Alopecia areata developing paralell to improvement of psoriasis during ustekinumab therapy. J Dermatol Case Rep 2011; 4:15-7. [PMID: 21886740 DOI: 10.3315/jdcr.2010.1041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 03/05/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ustekinumab is a new immunosuppressive anti-psoriasis agent. The drug targets the p40 subunit of IL-12 and IL-23 and indirectly inhibits cytokine production by Th17 cells. MAIN OBSERVATIONS We present a case of a 36-year-old male patient with psoriasis, who received ustekinumab therapy, applied in 45mg subcutaneous injections at week 0, 4 and than every 12 weeks. After 7 months of therapy PASI decreased from 10,1 to 0,9. At this phase of therapy he developed two patches of alopecia areata on the scalp. The diagnosis was made based on clinical appearance and was confirmed by trichoscopy (hair and scalp dermoscopy) and reflectance confocal microscopy. The development of alopecia areata was preceded by emotional stress and dental infection. CONCLUSIONS Ustekinumab seems an unlikely cause of alopecia areata in this patient. However, lack of efficacy is preventing hair loss may indicate that interleukin- 12 cytokine family is not a key player in pathogenesis of alopecia areata.
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The spectrum of hair loss in patients with mycosis fungoides and Sézary syndrome. J Am Acad Dermatol 2011; 64:53-63. [DOI: 10.1016/j.jaad.2009.12.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/23/2009] [Accepted: 12/31/2009] [Indexed: 11/18/2022]
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Barahmani N, Schabath MB, Duvic M. History of atopy or autoimmunity increases risk of alopecia areata. J Am Acad Dermatol 2009; 61:581-91. [PMID: 19608295 DOI: 10.1016/j.jaad.2009.04.031] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 04/01/2009] [Accepted: 04/03/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND The association between a history of atopy or autoimmune diseases and risk of alopecia areata (AA) is not well established. OBJECTIVE The purpose of this study was to use the National AA Registry database to further investigate the association between history of atopy or autoimmune diseases and risk of AA. METHODS A total of 2613 self-registered sporadic cases (n = 2055) and controls (n = 558) were included in this analysis. RESULTS Possessing a history of any atopic (odds ratio = 2.00; 95% confidence interval 1.50-2.54) or autoimmune (odds ratio = 1.73; 95% confidence interval 1.10-2.72) disease was associated with an increased risk of AA. There was no trend for possessing a history of more than one atopic or autoimmune disease and increasing risk of AA. LIMITATIONS Recall, reporting, and recruiting bias are potential sources of limitations in this analysis. CONCLUSION This analysis revealed that a history of atopy and autoimmune disease was associated with an increased risk of AA and that the results were consistent for both the severe subtype of AA (ie, alopecia totalis and alopecia universalis) and the localized subtype (ie, AA persistent).
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Affiliation(s)
- Nazila Barahmani
- Department of Dermatology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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