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Liu C, Liu X, Xin H, Li X. A Mendelian randomization study on the causal effects of circulating cytokines on the risk of vitiligo. Front Med (Lausanne) 2024; 11:1375339. [PMID: 38695020 PMCID: PMC11061512 DOI: 10.3389/fmed.2024.1375339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/12/2024] [Indexed: 05/04/2024] Open
Abstract
Background Accumulating evidence reveals an association between circulating cytokine levels and vitiligo. However, the causal association between circulating cytokine levels and vitiligo remains unrevealed. Methods We performed a two-sample Mendelian randomization (MR) analysis using a genome-wide association study of the 41 cytokines dataset, which was conducted with 3 Finnish cohorts (n = 8,293). Vitiligo data were acquired from strictly defined vitiligo data collected by FinnGenbiobank analysis, which included 207,613 European ancestors (131 vitiligo patients, 207,482 controls). The inverse-variance weighted (IVW) method, weighted median (WME), simple model, weighted model, and MR-Egger were used to determine the changes in vitiligo pathogenic cytokine taxa, followed by sensitivity analysis, including horizontal pleiotropy analysis. The MR Steiger test evaluated the strength of a causal association, and the leave-one-out method was used to assess the reliability of the results. The possibility of reverse causality was also investigated using a reverse MR study. Results We observed that rising IL-4 levels generated an enhanced probability of vitiligo in IVW (OR 2.72, 95%CI 1.19-6.22, p = 0.018). According to the results of the MR analysis, there were causal links between IL-4 and vitiligo. Results were steady after sensitivity and heterogeneity analyses. Conclusion Our research reveals that a genetically determined increased level of circulating IL-4 may be linked to a higher risk of developing vitiligo. The development of innovative treatment approaches (such as tofacitinib or dupilumab) that focus on blocking IL-4 as a novel way of preventing and treating vitiligo is significantly impacted by our findings.
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Affiliation(s)
- Chengling Liu
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
| | - Xingchen Liu
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Haiming Xin
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
| | - Xin Li
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
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Hayran Y, Yücel Ç, Oğuz EF, Eren F, Turhan T, Yalçın B. Serum Levels of IL-35, One of the Newest Members of Interleukin-12 Family of Cytokines, in Patients With Vitiligo. Dermatol Pract Concept 2024; 14:dpc.1402a69. [PMID: 38810045 PMCID: PMC11135918 DOI: 10.5826/dpc.1402a69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Vitiligo is a chronic skin disorder in which immune dysregulation has been reported as one of the major etiopathological factors. Interleukin-12 (IL-12), IL-23 and IL-27 of IL-12 cytokine family were identified as critical cytokines in the pathogenesis of many autoimmune and inflammatory skin diseases including vitiligo. IL-35 is one of the newest member of IL-12 cytokine family. OBJECTIVES The purpose of our study was to examine serum IL-35 levels in addition to serum IL-12, IL-23, IL-27 levels in the vitiligo patients and control group, and to investigate the relationship of these cytokines with the characteristics of vitiligo. METHODS Serum IL-12, IL-23, IL-27 and IL-35 levels of 87 vitiligo patients and 70 healthy volunteers were analyzed using the enzyme-linked immunosorbent assay (ELISA). We compared the IL-12 cytokine family levels in the patient and control groups, and investigated the relationship of these levels with the characteristics of vitiligo. RESULTS Patients had higher levels of IL-12 (31.2 versus 20.1, P < 0.001) and IL-35 (9.6 versus 8.1, P = 0.031). Patient and control groups had similar levels of IL-23 (P = 0.78) but were correlated with the Vitiligo Area Scoring Index (VASI) (P = 0.022, r = 0.35). Patients had lower levels of IL-27 (207.6 versus 258.7, P < 0.001). In addition, the levels of serum IL-27 were correlated negatively with the Vitiligo Disease Activity (VIDA), and positively with disease duration (P = 0.007, r = 0.30). CONCLUSIONS Differences of serum levels between Vitiligo patients and healthy controls, significant relationships with the characteristics of vitiligo suggest that the IL-12 cytokine family may play a role in the pathogenesis of vitiligo.
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Affiliation(s)
- Yıldız Hayran
- Department of Dermatology, Ankara City Hospital, Ankara, Turkey
| | - Çiğdem Yücel
- Department of Medical Biochemistry, University of Health Sciences, Gulhane Teaching and Research Hospital, Ankara, Turkey
| | - Esra Fırat Oğuz
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
| | - Funda Eren
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
| | - Turan Turhan
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
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Xerfan EMS, Andersen ML, Tufik S, Facina AS, Tomimori J. The impact on the quality of life and sleep complaints in a vitiligo sample and the influence of inflammatory cytokines in the interaction between vitiligo and sleep. Cytokine 2024; 176:156493. [PMID: 38246012 DOI: 10.1016/j.cyto.2023.156493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/21/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Vitiligo is an autoimmune dermatosis that affects quality of life, which englobes sleep quality. Sleep regulates the immune system, including inflammatory cytokines, and other pathways, which may influence vitiligo pathogenesis. OBJECTIVES To analyze levels of immune serum components (cytokines) in a vitiligo group, and assess whether there was any association with sleep. METHODS This study comprised 30 vitiligo patients and 26 control individuals. Quality of life and sleep questionnaires were completed [Dermatology Life Quality Index (DLQI), Short-Form Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI)]. Seven cytokines have been measured: IFN-γ, interleukin (IL)-4, IL-6, IL-10, IL-17A, IL-12 p40 and TNF-α. RESULTS The mean age of the vitiligo group was 47.7 years-old, with prevalence of females (66.7 %). Mucosal (70 %), acral (60 %) and focal subtype (53.3 %) predominated. Signs of vitiligo activity were identified in 63.3 % of the disease sample. Total PSQI scores and scores for domain 4 (sleep efficiency) were statistically worse in vitiligo group. The SF-36 and ISI total scores were worse in the vitiligo group, although not statistically significant compared with controls. Four SF-36 domains were statistically worse in vitiligo sample, and the DLQI mean score was mild to moderate (5.57). Cytokine levels were not different between groups, or when associated with PSQI. Higher ISI scores (more severe insomnia) were related to increased IL-17A. Higher IL-4, IL-6 and IL-10 levels were associated with previous phototherapy. CONCLUSIONS Poor sleep and impaired aspects of quality of life predominated in the vitiligo sample. Insomnia was related to IL-17A increase in vitiligo. Increased levels of IL-4, IL-6 and IL-10 were related to previous ultraviolet B narrow band (UVB-NB) phototherapy, suggesting an interaction of this treatment on immune system. Sleep disruption and the course of vitiligo may have common pathways in respect of circadian cytokines, which may represent an important subject in vitiligo management.
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Affiliation(s)
- Ellen M S Xerfan
- Postgraduate Program In Translational Medicine, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Dermatology, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica L Andersen
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Sleep Institute, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Sleep Institute, São Paulo, Brazil
| | - Anamaria S Facina
- Department of Dermatology, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Jane Tomimori
- Postgraduate Program In Translational Medicine, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Dermatology, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Sengupta R, Roy M, Dey NS, Kaye PM, Chatterjee M. Immune dysregulation and inflammation causing hypopigmentation in post kala-azar dermal leishmaniasis: partners in crime? Trends Parasitol 2023; 39:822-836. [PMID: 37586987 DOI: 10.1016/j.pt.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
Post kala-azar dermal leishmaniasis (PKDL), a heterogeneous dermal sequela of visceral leishmaniasis (VL), is challenging in terms of its etiopathogenesis. Hypopigmentation is a consistent clinical feature in PKDL, but mechanisms contributing to the loss of melanocytes remains poorly defined. Like other hypopigmentary dermatoses - for example, vitiligo, psoriasis, and leprosy - the destruction of melanocytes is likely a multifactorial phenomenon, key players being immune dysregulation and inflammation. This review focuses on immunological mechanisms responsible for the 'murder' of melanocytes, prime suspects at the lesional sites being CD8+ T cells and keratinocytes and their criminal tools being proinflammatory cytokines, for example, IFN-γ, IL-6, and TNF-α. Collectively, these may cause decreased secretion of melanocyte growth factors, loss/attenuation of cell adhesion molecules and inflammasome activation, culminating in melanocyte death.
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Affiliation(s)
- Ritika Sengupta
- Dept. of Pharmacology, Institute of Post Graduate Medical Education and Research, 244B AJC Bose Road, Kolkata 700020, India
| | - Madhurima Roy
- Dept. of Pharmacology, Institute of Post Graduate Medical Education and Research, 244B AJC Bose Road, Kolkata 700020, India
| | - Nidhi S Dey
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK
| | - Paul M Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK
| | - Mitali Chatterjee
- Dept. of Pharmacology, Institute of Post Graduate Medical Education and Research, 244B AJC Bose Road, Kolkata 700020, India.
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Zapata-Salazar NA, Kubelis-Lopez DE, Salinas-Santander MA, Sanchez-Dominguez CN, Xolalpa-Rosales AC, Gomez-Galindo ME, Ocampo-Candiani J. Association of rs4711998 of IL-17A, rs2275913 of IL-17A and rs763780 IL-17F gene polymorphisms with non-segmental vitiligo in a Mexican population. Arch Dermatol Res 2023; 315:447-454. [PMID: 35960353 DOI: 10.1007/s00403-022-02382-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/27/2022] [Accepted: 08/02/2022] [Indexed: 12/27/2022]
Abstract
Vitiligo is the most common depigmenting disease characterized by achromic macules due to selective loss of melanocytes. The pathogenesis remains poorly elucidated, and multiple hypotheses exist regarding its pathogenesis. Evidence suggests that stress on melanocytes can result in activation of the immune system, and involvement of both activated cluster of differentiation (CD8+) cytotoxic and CD4+ T cells in the dysfunction, depigmentation, and apoptosis of melanocytes. Recent studies show that the interleukin 17 (IL-17) axis plays a central role in the pathogenesis of the disease. IL-17 is an important regulatory effector cytokine in this pathway. The aim of this study was to evaluate the association of IL-17A rs4711998 (-832A/G), IL-17A rs2275913 (-197G/A), and IL-17F rs763780 (7488A/G) with vitiligo in a Northeastern Mexican population. This was a case-control study and included 116 patients with vitiligo and 116 control subjects. Genotype characterization of IL-17A rs4711998 (-832A/G), IL-17A rs2275913 (-197G/A), and IL-17F rs763780 (7488A/G) was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. A p ≤ 0.05 was considered significant. It was observed that the combination of the genotypes GG/GA for IL-17F rs763780 (7488A/G) was associated with an increased risk for the development of vitiligo (OR 2.0943, 95% Cl 1.2375-3.5445, p = 0.0056). Regarding IL-17A rs4711998 (-832A/G) and IL-17A rs2275913 (-197G/A) genotyping, no association with vitiligo development was found. In conclusion, the SNP rs763780 in the IL-17F gene appears to be a risk factor for vitiligo development in this Mexican population and it may be useful in future studies, especially for the development of new therapies.
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Affiliation(s)
- Natalia Aranza Zapata-Salazar
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon (UANL), Av. Madero and Gonzalitos S/N, Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico
| | - David Emmanuel Kubelis-Lopez
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon (UANL), Av. Madero and Gonzalitos S/N, Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico
| | | | - Celia Nohemi Sanchez-Dominguez
- Department of Biochemistry and Molecular Medicine, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon (UANL), Monterrey, Nuevo Leon, Mexico
| | - Ana Cecilia Xolalpa-Rosales
- Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon (UANL), Monterrey, Nuevo Leon, Mexico
| | - Marely Eugenia Gomez-Galindo
- Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon (UANL), Monterrey, Nuevo Leon, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon (UANL), Av. Madero and Gonzalitos S/N, Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico.
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Fazeli Z, Abdollahimajd F, Atazadeh F, Karimi M, Alikhani A, Aryan A, Asadi K. The association of Interleukin-10 and Interleukin-13 polymorphisms with susceptibility to vitiligo: A study in Iranian patients. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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7
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Beyzaee AM, Goldust M, Patil A, Rokni GR, Beyzaee S. The role of cytokines and vitamin D in vitiligo pathogenesis. J Cosmet Dermatol 2022; 21:6314-6325. [PMID: 35871394 DOI: 10.1111/jocd.15272] [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: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 12/27/2022]
Abstract
Vitiligo is a pigment-related disease with a global prevalence of 0.2% to 1.8% associated with considerable burden on quality of life. The treatment is still a challenge because of relapses and/or incomplete re-pigmentation. Although the exact cause is still unclear, its pathogenesis seems to be justifiable with the autoimmune theory, supported by the results of clinical research. In this narrative review, we aimed to summarize the evidence related to cytokines and vitiligo development. This review is consisted of English articles published in PubMed and Google Scholar concerning levels of inflammatory mediators, especially interleukins, in vitiligo patients over the last 20 years. References of relevant articles were also considered for review. Crucial role of dysregulated levels of interleukins and their synergistic function to each other, in the onset or progression of the disease is evident. The theory of autoimmune vitiligo is reinforced by the results of the studies in the literature, due to the association of pathogenesis with increased secretion of pro-inflammatory mediators and reduction of anti-inflammatory mediators. Decreased vitamin D levels may have a considerable role in vitiligo development by affecting Th1- and Th17-related immune responses. Cytokines play an important role in the pathogenesis or progression of the disease. Moreover, we believe that decreased vitamin D level has a considerable role in vitiligo development by affecting Th1- and Th17-related immune responses.
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Affiliation(s)
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Ghasem Rahmatpour Rokni
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samira Beyzaee
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Xu X, Jiang M, Zhang C, Qiao Z, Liu W, Le Y, Wu J, Ma W, Xiang LF. New insights into segmental vitiligo: A clinical and immunological comparison with nonsegmental vitiligo. Pigment Cell Melanoma Res 2021; 35:220-228. [PMID: 34780118 DOI: 10.1111/pcmr.13022] [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: 05/11/2021] [Revised: 10/07/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
The overlaps between segmental vitiligo (SV) and nonsegmental vitiligo (NSV) suggest the underlying features of SV, which may be helpful for treating SV. In this study, 379 vitiligo patients were recruited and divided into SV (33.2%), mild-to-moderate NSV (M-NSV, affected body affected area [BSA] ≤10%, 34.0%), and severe NSV (S-NSV, affected BSA >10%, 32.7%) groups. Demographics and clinical data were collected through in-person interviews. The disease activity, progression, and prognosis were assessed through 6 months' follow-up. Serum cytokines profile and tissue-infiltrating immune cells were measured by ELISA assay and immunofluorescence, respectively. The SV exhibited lower rates of autoimmune comorbidities and recurrence than the S-NSV, but performed similar to the M-NSV. Moreover, the disease activity, progression, serum cytokines profile, and tissue-infiltrating Th/c1 cells in the active SV and M-NSV were comparable, but differed significantly from those of the active S-NSV. The clinical and immunological similarities between SV and M-NSV presented a deeper autoimmune understanding of SV. Additionally, a classification of active vitiligo according to disease extent may be more clinically meaningful than subtypes for guiding immunomodulatory treatment.
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Affiliation(s)
- Xinya Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Jiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhuhui Qiao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjie Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Le
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaqiang Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjuan Ma
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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Mahmoud Marie RES, Adel AZM, Abd El-Fadeal NM, Eyada MMK. Interleukin 38 serum level is increased in patients with vitiligo, correlated with disease severity, and associated with signs of disease activity. J Cosmet Dermatol 2021; 21:3515-3521. [PMID: 34783147 DOI: 10.1111/jocd.14612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vitiligo is an acquired cutaneous depigmenting disease caused by a T helper (Th) 1-cytotoxic T cells driven autoimmune attack against melanocytes, in which Th17 is also involved. Interleukin (IL)-38 belongs to the IL-1 family of cytokines and suppresses Th1 and Th17 activation. IL-38 protein and mRNA levels have been found to be elevated in various autoimmune disorders and correlated with disease severity and activity, including psoriasis, systemic sclerosis, rheumatoid arthritis, and atopic dermatitis. No previous studies have been performed to investigate the expression of IL-38 in patients with vitiligo. AIM To evaluate IL-38 serum level in patients with vitiligo compared to healthy controls (Hcs) and examine the association between IL-38 level and severity and activity of vitiligo. PATIENTS AND METHODS The study comprised 21 patients with vitiligo and 21 Hcs. Vitiligo severity and activity were evaluated via Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) Score, respectively. IL-38 serum level was evaluated by enzyme-linked immunosorbent assay. RESULTS Vitiligo patients had significantly higher serum level of IL-38 than Hcs (p < 0.001). This level was significantly higher among patients with signs of vitiligo activity (p = 0.048), correlated positively with VES (p < 0.001), and correlated negatively with the age of patients (p = 0.001) and the age of disease onset (p = 0.022). CONCLUSION IL-38 serum level was higher in patients with vitiligo than in Hcs and was related to vitiligo severity and signs of activity.
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Affiliation(s)
- Radwa El-Sayed Mahmoud Marie
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Al-Zahraa Mohamed Adel
- Department of Dermatology, Medical Services Administration, Suez Canal University, Ismailia, Egypt
| | - Noha M Abd El-Fadeal
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Oncology Diagnostic Unit, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Moustafa Mohamad Kamel Eyada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Leung AKC, Lam JM, Leong KF, Hon KL. Vitiligo: An Updated Narrative Review. Curr Pediatr Rev 2021; 17:76-91. [PMID: 33302860 DOI: 10.2174/1573396316666201210125858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. OBJECTIVE This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. METHODS A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English language. The information retrieved from the above search was used in the compilation of the present article. RESULTS Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. CONCLUSION The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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11
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Egbeto IA, Garelli CJ, Piedra-Mora C, Wong NB, David CN, Robinson NA, Richmond JM. Case Series: Gene Expression Analysis in Canine Vogt-Koyanagi-Harada/Uveodermatologic Syndrome and Vitiligo Reveals Conserved Immunopathogenesis Pathways Between Dog and Human Autoimmune Pigmentary Disorders. Front Immunol 2020; 11:590558. [PMID: 33384688 PMCID: PMC7770226 DOI: 10.3389/fimmu.2020.590558] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
Vogt-Koyanagi-Harada syndrome (VKH) and vitiligo are autoimmune diseases that target melanocytes. VKH affects several organs such as the skin, hair follicle, eyes, ears, and meninges, whereas vitiligo is often limited to the skin and mucosa. Many studies have identified immune genes, pathways and cells that drive the pathogeneses of VKH and vitiligo, including interleukins, chemokines, cytotoxic T-cells, and other leukocytes. Here, we present case studies of 2 canines with VKH and 1 with vitiligo, which occurred spontaneously in client-owned companion dogs. We performed comparative transcriptomics and immunohistochemistry studies on lesional skin biopsies from these cases in order to determine if the immunopathogenesis of autoimmune responses against melanocytes are conserved. In dogs, we found enrichment of T cell gene signatures, with upregulation of IFNG, TNF, PRF1, IL15, CTSW, CXCL10, and CCL5 in both VKH and vitiligo in dogs compared to healthy controls. Similar findings were reported in humans, suggesting that these genes play a role in the pathogenesis of spontaneous VKH and vitiligo. T cell-associated genes, including FOXP3 and TBX21, were enriched, while IGFBP5, FOXO1, and PECAM1 were decreased compared to healthy controls. Further, we identified TGFB3, SFRP2, and CXCL7 as additional potential drivers of autoimmune pigmentary disorders. Future studies exploring the immunopathogenesis of spontaneous autoimmunity will expand our understanding of these disorders, and will be useful in developing targeted therapies, repurposing drugs for veterinary and human medicine, and predicting disease prognosis and treatment response.
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Affiliation(s)
- Ista A Egbeto
- Department of Dermatology, UMass Medical School, Worcester, MA, United States.,Tufts University School of Medicine, Boston, MA, United States
| | - Colton J Garelli
- Department of Dermatology, UMass Medical School, Worcester, MA, United States
| | - Cesar Piedra-Mora
- Pathology Department, Tufts Cummings School of Veterinary Medicine, Grafton, MA, United States
| | - Neil B Wong
- Department of Dermatology, UMass Medical School, Worcester, MA, United States
| | | | - Nicholas A Robinson
- Pathology Department, Tufts Cummings School of Veterinary Medicine, Grafton, MA, United States
| | - Jillian M Richmond
- Department of Dermatology, UMass Medical School, Worcester, MA, United States
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12
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Abstract
OBJECTIVES Vitiligo is an autoimmune disease, and its pathogenesis involves changes in cytokine levels in the affected patients. Tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and IL-17 from pro-inflammatory cytokines, IL-37 in a recently detected anti-inflammatory activity. The aim of our study was to determine serum TNF-α, IL-6, IL-17, IL-37 levels in patients with vitiligo to understand their possible roles in the disease etiology and to compare the results with the healthy controls. METHODS The study included 48 generalized vitiligo patients who were diagnosed with vitiligo, had an increase in the lesions within the last 3 months, and did not receive any systemic or topical treatment during this period; furthermore, 18 healthy controls were included. RESULTS Patient group: n = 48, mean age = 30.48 ± 9.86 years; control group: n = 18, mean age = 28.27 ± 9.66 years. Individuals in the patient group had significantly higher serum levels of IL-37(t = 3.90, p < .001), IL-6 (t = 3.39, p < .05), IL-17 (t = 2.08, p < .05), and TNF-α (t = 4.69 p < .001) than in the control group. CONCLUSION The high levels of (pro-anti) inflammatory cytokines in vitiligo patients draw attention to the importance of cytokines in the pathogenesis of the disease.
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Affiliation(s)
- Ebru Karagün
- Department of Dermatology, Duzce University Medical School, Duzce, Turkey
| | - Sevim Baysak
- Department of Dermatology, Istanbul Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
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13
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Rahimi A, Hossein-Nataj H, Hajheydari Z, Aryanian Z, Shayannia A, Ajami A, Asgarian-Omran H. Expression analysis of PD-1 and Tim-3 immune checkpoint receptors in patients with vitiligo; positive association with disease activity. Exp Dermatol 2020; 28:674-681. [PMID: 31046170 DOI: 10.1111/exd.13952] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/24/2019] [Indexed: 12/24/2022]
Abstract
The contribution of immune checkpoint receptors in the immunopathogenesis of various autoimmune diseases has been addressed in previous reports. In this study, the expression profile of T-cell immunoglobulin and mucin-domain containing-3 (Tim-3) and programmed cell death-1 (PD-1) checkpoint molecules was investigated in CD8+ T cells of Vitiligo patients. The association of Tim-3 and PD-1 expression with disease activity was also explored. The frequency of Tim-3+ /PD-1+ /CD8+ T cells in 30 patients with vitiligo and 30 sex- and age-matched controls was determined by flow cytometry. CD8+ T cells were then positively isolated by magnetic beads, and the mRNA expression of PD-1 and Tim-3 was determined by TaqMan-based real-time PCR. To measure the cytokines production, PBMCs were stimulated with PMA/ionomycin and concentrations of IL-4, IFN-γ and TNF-α were measured in culture supernatants by ELISA. Disease activity of patients with vitiligo was determined using the Vitiligo Area Severity Index. Patients with vitiligo have significantly shown more expression of Tim-3 and PD-1 on their CD8+ T cells compared with controls. Expression analysis of Tim-3 mRNA, but not PD-1, confirmed the results obtained from flow cytometry. While the production levels of TNF-α and IFN-γ were found higher by patients with vitiligo, IL-4 production was lower in patients compared with controls. A direct association was observed between the Tim-3 and PD-1 expression and also the production of pro-inflammatory cytokines with disease activity of patients with vitiligo. Our results indicate that Tim-3 and PD-1 are involved in immune dysregulation mechanisms of CD8+ T cells in vitiligo and may introduce as potential biomarkers for disease progression and targeted immunotherapy.
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Affiliation(s)
- Ali Rahimi
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hadi Hossein-Nataj
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Hajheydari
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Aryanian
- Department of Dermatology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Asghar Shayannia
- Department of Medical Biotechnology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Abolghasem Ajami
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Asgarian-Omran
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
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14
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Ebrahimabadi MH, Lamardi SNS, Shirbeigi L. Immunomodulatory Effects of Medicinal Plants used for Vitiligo in Traditional Persian Medicine. Curr Drug Discov Technol 2020; 18:160-178. [PMID: 32416680 DOI: 10.2174/1570163817666200517115438] [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: 10/23/2019] [Revised: 02/14/2020] [Accepted: 03/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitiligo is a hypopigmentation disorder that affects 1% of the world's population. Vitiligo causes white spots on the skin, mucous membranes, or white hair by destroying skin melanocytes. The pathogenesis of vitiligo is unknown but autoimmune, autocytotoxic, and neural mechanisms are suggested. According to the autoimmune theory, in people with vitiligo, immune cells invade and damage melanocytes. T cells are more commonly present in vitiligo patients' skin and remain in the lesion site, which is composed of CD8 and CD4 T cells. Many studies have been conducted on the presence and role of cytokines such as interleukins and interferongamma (IFN-γ) in the vitiligo process. AIM This study aimed to introduce herbs effective against vitiligo from the perspective of Persian medicine and to investigate their possible therapeutic mechanisms with the possible effects of herbs on autoimmune mechanisms. METHODS For this purpose, keywords were used to extract data from Persian medicine textbooks, and then relevant scientific databases, including Google Scholar, PubMed, Web of Science, and Scopus were examined. RESULTS It was found that Persian medicine scholars used 50 different medicinal plants to treat and reduce the complications of vitiligo, and recent scientific studies have proven immune-regulating properties and reducing the effect of many of them on cytokines. CONCLUSION According to scientific evidence on immunomodulatory effects, new research into the effects of these plants on vitiligo can lead to the discovery of new drugs and approaches for treating this disease.
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Affiliation(s)
- Mohsen Haghir Ebrahimabadi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Laila Shirbeigi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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15
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Bellei B, Picardo M. Premature cell senescence in human skin: Dual face in chronic acquired pigmentary disorders. Ageing Res Rev 2020; 57:100981. [PMID: 31733332 DOI: 10.1016/j.arr.2019.100981] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 01/10/2023]
Abstract
Although senescence was originally described as an in vitro acquired cellular characteristic, it was recently recognized that senescence is physiologically and pathologically involved in aging and age-related diseases in vivo. The definition of cellular senescence has expanded to include the growth arrest caused by various cellular stresses, including DNA damage, inadequate mitochondria function, activated oncogene or tumor suppressor genes and oxidative stress. While senescence in normal aging involves various tissues over time and contributes to a decline in tissue function even with healthy aging, disease-induced premature senescence may be restricted to one or a few organs triggering a prolonged and more intense rate of accumulation of senescent cells than in normal aging. Organ-specific high senescence rate could lead to chronic diseases, especially in post-mitotic rich tissue. Recently, two opposite acquired pathological conditions related to skin pigmentation were described to be associated with premature senescence: vitiligo and melasma. In both cases, it was demonstrated that pathological dysfunctions are not restricted to melanocytes, the cell type responsible for melanin production and transport to surrounding keratinocytes. Similar to physiological melanogenesis, dermal and epidermal cells contribute directly and indirectly to deregulate skin pigmentation as a result of complex intercellular communication. Thus, despite senescence usually being reported as a uniform phenotype sharing the expression of characteristic markers, skin senescence involving mainly the dermal compartment and its paracrine function could be associated with the disappearance of melanocytes in vitiligo lesions and with the exacerbated activity of melanocytes in the hyperpigmentation spots of melasma. This suggests that the difference may arise in melanocyte intrinsic differences and/or in highly defined microenvironment peculiarities poorly explored at the current state of the art. A similar dualistic phenotype has been attributed to intratumoral stromal cells as cancer-associated fibroblasts presenting a senescent-like phenotype which influence the behavior of neoplastic cells in either a tumor-promoting or tumor-inhibiting manner. Here, we present a framework dissecting senescent-related molecular alterations shared by vitiligo and melasma patients and we also discuss disease-specific differences representing new challenges for treatment.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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16
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Lotti T, Gianfaldoni S, Valle Y, Rovesti M, Feliciano C, Satolli F. Controversial issues in vitiligo patients: a review of old and recent treatments. Dermatol Ther 2018; 32:e12745. [DOI: 10.1111/dth.12745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Torello Lotti
- Dermatology and Venereology; University G. Marconi of Rome; Rome Italy
| | | | - Yan Valle
- University G.Marconi of Rome; Rome Italy
| | - Miriam Rovesti
- Dermatology and Venereology; University of Parma; Parma Italy
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