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Ma YQ, Sun Z, Li YM, Xu H. Oxidative stress and alopecia areata. Front Med (Lausanne) 2023; 10:1181572. [PMID: 37396920 PMCID: PMC10311488 DOI: 10.3389/fmed.2023.1181572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Alopecia areata (AA) is an inflammatory autoimmune disease characterized by non-scarring hair loss on the scalp or any other part of the hair-bearing skin. While the collapse of the immune privilege is considered as one of the most accepted theories accounting for AA, the exact pathogenesis of this disease remains unclear by now. Other factors, such as genetic predisposition, allergies, microbiota, and psychological stress, also play an important role in the occurrence and development of AA. Oxidative stress (OS), an unbalance between the oxidation and antioxidant defense systems, is believed to be associated with AA and may trigger the collapse of hair follicle-immune privilege. In this review, we examine the evidence of oxidative stress in AA patients, as well as the relationship between the pathogenesis of AA and OS. In the future, antioxidants may play a new role as a supplementary therapy for AA.
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Affiliation(s)
| | | | | | - Hui Xu
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Alopecia Areata: A Review of the Role of Oxidative Stress, Possible Biomarkers, and Potential Novel Therapeutic Approaches. Antioxidants (Basel) 2023; 12:antiox12010135. [PMID: 36670997 PMCID: PMC9854963 DOI: 10.3390/antiox12010135] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Alopecia areata (AA) is a dermatological condition characterized by non-scarring hair loss. Exact etiopathogenesis of AA is still unknown although it is known that several factors contribute to the collapse of the hair-follicle (HF)-immune-privileged (IP) site. Oxidative stress (OS) plays an important role in skin diseases. The aim of this review was to clarify the role of OS in AA pathogenesis and diagnosis, and to discuss potential treatment options. Oxidative-stress markers are altered in serum and skin samples of patients with AA, confirming a general pro-oxidative status in patients with AA. OS induces MHC class I chain-related A (MICA) expression in HF keratinocytes that activates the receptor NKG2D, expressed in NK cells and CD8+ T cytotoxic cells leading to destabilization of the HF immune-privileged site through the production of IFN-γ that stimulates JAK1 and JAK2 pathways. OS also activates the KEAP1-NRF2 pathway, an antioxidant system that contributes to skin homeostasis. In addition, a decrease of ATG5 and LC3B in the hair matrix and an increase in p62 levels indicates a reduction of intrafollicular autophagy during the evolution of AA. Potential biomarkers of OS in AA could be: malondialdehyde (MDA), advanced glycation end-products (AGEs), and ischemic-modified albumin (IMA). JAK inhibitors are the new frontier in treatment of AA and the use of nutraceuticals that modulate the OS balance, in combination with standard treatments, represent promising therapeutic tools.
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Paraoxonase 1 (PON1) gene Q192R polymorphism in patients with vitiligo. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1060981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background/Aim: Vitiligo is a prevalent inflammatory illness that can affect the skin and mucosal surfaces and is characterized by patchy loss of skin pigmentation. Paraoxonase1 (PON1) is an esterase enzyme with antioxidant properties that binds to high-density lipoproteins. We examined whether the PON1 gene Q192R polymorphism is a risk factor for vitiligo among Turkish people.
Methods: The study included 70 controls and 60 vitiligo cases. Polymerase chain reaction and the restriction fragment length polymorphism technique were used to genotype the PON1 gene Q192R polymorphism.
Results: PON1 gene Q192R genotype distribution was 66.7% QQ, 33.3% QR, and 0% RR in the vitiligo and 81.4% QQ, 18.6% QR, and 0% RR in the control (P = 0.05). When vitiligo patients were compared with controls, the prevalence of the PON1 QR genotype was substantially higher and was linked to a 2.19-fold greater risk of developing vitiligo (odds ratio: 2.19, 95% confidence interval (CI): 0.97–4.91).
Conclusion: These findings imply that Q192R polymorphisms in the PON-1 gene may be linked to vitiligo in the Turkish population. The PON1 QR genotype may be a major genetic risk factor for vitiligo susceptibility and progression. Further studies with larger populations should more thoroughly clarify the association.
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Taskin S, Celik H, Cakirca G, Manav V, Taskin A. Nitric oxide synthase activity: A novel potential biomarker for predicting Alopecia areata. J Cosmet Dermatol 2022; 21:7075-7080. [PMID: 36093562 DOI: 10.1111/jocd.15378] [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: 03/30/2022] [Revised: 07/01/2022] [Accepted: 09/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alopecia areata is a dermatological disease characterized by nonscarring type hair loss. The cause of Alopecia areata not known exactly but studies support that it has an autoimmune etiology in which oxidative stress play an important role. AIM This study was conducted to evaluate the level of nitrosative stress in Alopecia areata and to investigate the predictive power of nitrosative stress parameters for Alopecia areata. PATIENTS/METHODS Thirty patients diagnosed with Alopecia areata, and 30 healthy controls were included in a prospective, cross-sectional study. In both groups, nitric oxide (NO· ), peroxynitrite (ONOO- ), and nitric oxide synthase (NOS) activity as nitrosative stress markers were measured spectrophotometrically in serum samples. The predictive power of nitrosative stress parameters in Alopecia areata and control groups was compared with binary logistic regression and Receiver Operating Characteristic analysis. RESULTS NO· , ONOO- , and NOS activity were significantly higher in patients with Alopecia areata than in the control group (p = 0.001; p < 0.001; p < 0.001, respectively). A positive correlation was found between the parameters. Significantly, binary logistic regression modeling suggested that increases in NOS (p = 0.003, OR = 1.305, 95% CI = 1.095-1.556) activity were associated with Alopecia areata. CONCLUSION According to the data obtained from the present study, patients with Alopecia areata were exposed to potent nitrosative stress. In particular, peroxynitrite, which acts as a bridge between reactive oxygen species and reactive nitrogen species, caused the expansion of the oxidative stress cascade. Nitrosative stress might play a role in the etiopathogenesis of Alopecia areata. Nitrosative stress parameters, particularly NOS activity, may be potential markers for Alopecia areata.
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Affiliation(s)
- Seyhan Taskin
- Department of Physiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Hakim Celik
- Department of Physiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Gokhan Cakirca
- Department of Biochemistry, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Vildan Manav
- Department of Dermatology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Abdullah Taskin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Harran University, Sanliurfa, Turkey
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Xie B, Sun J, Song X. Hair Follicle Melanocytes Initiate Autoimmunity in Alopecia Areata: a Trigger Point. Clin Rev Allergy Immunol 2022; 63:417-430. [PMID: 36121544 DOI: 10.1007/s12016-022-08954-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
Alopecia areata (AA) is characterized by common non-scarring alopecia due to autoimmune disorders. To date, the specific pathogenesis underlying AA remains unknown. Thus, AA treatment in the dermatological clinic is still a challenge. Numerous clinical observations and experimental studies have established that melanocytes may be the trigger point that causes hair follicles to be attacked by the immune system. A possible mechanism is that the impaired melanocytes, under oxidative stress, cannot be repaired in time and causes apoptosis. Melanocyte-associated autoantigens are released and presented, inducing CD8+ T cell attacks. Thereafter, amplification of the immune responses further spreads to the entire hair follicle (HF). The immune privilege of HF subsequently collapses, leading to AA. Herein, we present a narrative review on the roles of melanocytes in AA pathogenesis, aiming to provide a better understanding of this disease from the melanocyte's perspective.
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Affiliation(s)
- Bo Xie
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, West Lake Ave 38, Hangzhou, 310009, People's Republic of China
| | - Jiayi Sun
- Graduate School, Zhejiang Chinese Medical University, Binwen Rd 548, Hangzhou, 310053, People's Republic of China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, West Lake Ave 38, Hangzhou, 310009, People's Republic of China.
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Shakoei S, Mirmiranpoor H, Nakhjavani M, Nasimi M, Bakhshi G, Azizpour A. Oxidative stress and antioxidant markers in patients with alopecia areata: A comparative cross-sectional study. Indian J Dermatol Venereol Leprol 2022; 89:411-415. [DOI: 10.25259/ijdvl_228_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 02/01/2022] [Indexed: 11/04/2022]
Abstract
Background
Alopecia areata is a chronic inflammatory skin disease. Oxidative stress may contribute to the pathogenesis of this condition.
Aim
To evaluate the serum oxidative stress markers and antioxidant capacity in patients with alopecia areata.
Methods
This cross-sectional study was performed on 40 patients with alopecia areata and 40 healthy controls. The fasting blood sugar, C-reactive protein, lipid profile, and serum oxidative markers, including advanced glycation end products and advanced oxidation protein products, were measured in this study. Also, antioxidant enzymes, including paraoxonase-1, lecithin-cholesterol acyltransferase and serum ferric-reducing antioxidant power, were determined.
Results
The serum levels of advanced glycation end products and advanced oxidation protein products were significantly higher in patients with alopecia areata, compared to the controls (P < 0.001), whereas the levels of ferric-reducing antioxidant power, paraoxonase-1 and lecithin-cholesterol acyltransferase were significantly lower in patients with alopecia areata, compared to the controls (P < 0.001). The mean fasting blood sugar level was significantly higher in patients with alopecia areata, compared to the controls. The ferric reducing antioxidant power level was significantly associated with the percentage of hair loss (P = 0.01, r = 0.4) and the serum C-reactive protein level (P = 0.03, r = -0.3) in patients with alopecia areata.
Limitations
Since the current study had a cross-sectional design, no cause-effect relationship was established between alopecia areata and oxidative stress. The sample size of our study was also small.
Conclusion
Based on the present results, the oxidant-antioxidant enzymatic system is impaired in alopecia areata due to the increased oxidative products and decreased antioxidant activity.
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Affiliation(s)
| | - Hossein Mirmiranpoor
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran, Iran
| | - Maryam Nasimi
- Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Arghavan Azizpour
- Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Effectiveness of Platelet-Rich Plasma Therapy in Androgenic Alopecia—A Meta-Analysis. J Pers Med 2022; 12:jpm12030342. [PMID: 35330343 PMCID: PMC8953144 DOI: 10.3390/jpm12030342] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 01/25/2023] Open
Abstract
Platelet-rich plasma (PRP) represents a novel therapy tested and is used more and more frequently in dermatology and cosmetic surgery for a variety of conditions, including androgenic alopecia (AGA), a common condition with a complex pathogenesis involving genetic factors, hormonal status and inflammation. We performed an extensive literature search which retrieved 15 clinical trials concerning the use in AGA of PRP therapy, alone or in combination, in male, female or mixed patient groups. A quantitative statistical meta-analysis of n = 17 trial groups proved significant increases in hair density from 141.9 ± 108.2 to 177.5 ± 129.7 hairs/cm2 (mean ± SD) following PRP (p = 0.0004). To the best of our knowledge, this is the first meta-analysis that proved a statistically significant correlation between the number of PRP treatments per month and the percentage change in hair density (r = 0.5, p = 0.03), as well as a negative correlation between the mean age of treatment group and the percentage change in hair density (r = −0.56, p = 0.016). Other factors considered for analysis were the PRP preparation method, amount used per treatment, hair diameter, terminal hairs and pull test. We conclude that PRP represents a valuable and effective therapy for AGA in both males and females if patients are rigorously selected.
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Rynkowska A, Stępniak J, Karbownik-Lewińska M. Melatonin and Indole-3-Propionic Acid Reduce Oxidative Damage to Membrane Lipids Induced by High Iron Concentrations in Porcine Skin. MEMBRANES 2021; 11:membranes11080571. [PMID: 34436334 PMCID: PMC8400501 DOI: 10.3390/membranes11080571] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Iron excess in tissues results in increased oxidative damage. Among different tissues, the skin can particularly be severely damaged by oxidative stress, as it is exposed not only to endogenous but also directly to exogenous pro-oxidants. The skin is especially vulnerable to harmful oxidative stress. Melatonin and indole-3-propionic acid (IPA), two indole substances, are efficient antioxidants. This study aims to evaluate the potential protective effects of melatonin and IPA against oxidative damage to membrane lipids (lipid peroxidation (LPO)), induced in porcine skin homogenates by the Fenton reaction (Fe2+ + H2O2 → Fe3+ + •OH + OH−) when iron is used in extremely high concentrations. Skin homogenates were incubated in the presence of FeSO4 (2400, 1200, 600, 300, 150 and 75 µM) + H2O2 (5 mM) with/without melatonin or IPA. LPO level (MDA + 4-HDA/mg protein) was measured spectrophotometrically. Melatonin, in its highest used concentration (5.0 mM), prevented FeSO4 (1200 mM)-induced LPO, whereas it was effective in concentrations as low as 2.5 mM against all lower iron concentrations. IPA was protective in concentrations as low as 2.5 mM independently of FeSO4 concentration. In conclusion, melatonin and IPA effectively protect against oxidative damage to membrane lipids induced by high concentrations of iron in porcine skin; therefore, both can be considered pharmacological agents in the case of disorders associated with excessive iron accumulation in the skin.
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Affiliation(s)
- Aleksandra Rynkowska
- Department of Oncological Endocrinology, Medical University of Lodz, 90-752 Łódź, Poland; (A.R.); (J.S.)
| | - Jan Stępniak
- Department of Oncological Endocrinology, Medical University of Lodz, 90-752 Łódź, Poland; (A.R.); (J.S.)
| | - Małgorzata Karbownik-Lewińska
- Department of Oncological Endocrinology, Medical University of Lodz, 90-752 Łódź, Poland; (A.R.); (J.S.)
- Polish Mother’s Memorial Hospital—Research Institute, 93-338 Łódź, Poland
- Correspondence: or ; Tel.: +48-42-272-5249
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Sachdeva S, Khurana A, Goyal P, Sardana K. Does oxidative stress correlate with disease activity and severity in alopecia areata? An analytical study. J Cosmet Dermatol 2021; 21:1629-1634. [PMID: 34037317 DOI: 10.1111/jocd.14253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oxidative stress (OS) has been implicated as a contributory factor in the multifactorial etiopathogenesis of alopecia areata (AA). But with the existing data, it is unclear whether OS is a cause or effect of the disease state in Alopecia areata. AIMS To compare the OS parameters viz.malon-di-aldehyde (MDA), superoxide dismutase (SOD), total antioxidant status (TAS) in serum of patients with alopecia areata versus age and sex matched controls, and assess their correlation with the severity of the disease. PATIENTS/METHODS Forty clinically diagnosed patients of alopecia areata and forty (n = 40) age and sex-matched healthy controls were recruited. ELISA was used for the evaluation of MDA, and spectrophotometric method was used to evaluate serum TAS and whole blood SOD. RESULTS Mean serum TAS and whole blood SOD levels of cases were significantly lower than controls (p = 0.005 and p = 0.002, respectively). Mean serum MDA level of patients was significantly higher compared to controls (p = 0.001). While levels of serum TAS and whole blood SOD were found to decrease from mild to severe grades of disease (p = 0.003, p < 0.001 respectively), levels of MDA increased with increasing disease severity (p < 0.001). CONCLUSION The OS parameters were deranged in all subsets of AA, with the greatest derangement seen with whole blood SOD levels.
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Affiliation(s)
- Soumya Sachdeva
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vaypayee Institute of Medical Sciences, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vaypayee Institute of Medical Sciences, New Delhi, India
| | - Parul Goyal
- Department of Biochemistry, Dr Ram Manohar Lohia Hospital and Atal Bihari Vaypayee Institute of Medical Sciences, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vaypayee Institute of Medical Sciences, New Delhi, India
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The association of TNFα -238 G/A gene polymorphism with alopecia areata. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.892542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zohdy M, Tantawy M, Khabir A, Mahsoub N. Serum paroxonase 1 level may be an indicator and predictor of the severity of androgenetic alopecia. Int J Trichology 2021; 13:26-31. [PMID: 34934297 PMCID: PMC8647709 DOI: 10.4103/ijt.ijt_128_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/05/2021] [Accepted: 10/13/2021] [Indexed: 11/04/2022] Open
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Acharya P, Mathur MC. Oxidative stress in alopecia areata: a systematic review and meta‐analysis. Int J Dermatol 2019; 59:434-440. [DOI: 10.1111/ijd.14753] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Prakash Acharya
- Department of Dermatology College of Medical Sciences Bharatpur Nepal
| | - Mahesh C. Mathur
- Department of Dermatology College of Medical Sciences Bharatpur Nepal
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Ocampo-Garza J, Griggs J, Tosti A. New drugs under investigation for the treatment of alopecias. Expert Opin Investig Drugs 2019; 28:275-284. [DOI: 10.1080/13543784.2019.1568989] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jorge Ocampo-Garza
- Dermatology Department, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey,
México
| | - Jacob Griggs
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami,
FL, USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami,
FL, USA
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