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Senna MM, McMichael AJ, Mayo TT, Mackay-Wiggan J, Glashofer M, Sun L, Yu G, Nunes FP, McCollam JS, Wu WS, King B. 26143 Time to scalp hair, eyebrow, and eyelash improvement in patients with alopecia areata treated with baricitinib in the phase 2 portion of the phase 2/3 BRAVE-AA1 study. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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2
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Mackay-Wiggan J, Sallee BN, Wang EHC, Sansaricq F, Nguyen N, Kim C, Chen JC, Christiano AM, Clynes R. An open-label study evaluating the efficacy of abatacept in alopecia areata. J Am Acad Dermatol 2020; 84:841-844. [PMID: 33045294 DOI: 10.1016/j.jaad.2020.09.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Freda Sansaricq
- Department of Dermatology, Columbia University, New York, New York
| | - Nhan Nguyen
- Department of Dermatology, Columbia University, New York, New York
| | - Carey Kim
- Department of Dermatology, Columbia University, New York, New York
| | - James C Chen
- Department of Dermatology, Columbia University, New York, New York
| | - Angela M Christiano
- Department of Dermatology, Columbia University, New York, New York; Department of Genetics and Development, Columbia University, New York, New York.
| | - Raphael Clynes
- Department of Dermatology, Columbia University, New York, New York
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3
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Korta DZ, Christiano AM, Bergfeld W, Duvic M, Ellison A, Fu J, Harris JE, Hordinsky MK, King B, Kranz D, Mackay-Wiggan J, McMichael A, Norris DA, Price V, Shapiro J, Atanaskova Mesinkovska N. Alopecia areata is a medical disease. J Am Acad Dermatol 2018; 78:832-834. [PMID: 29548423 DOI: 10.1016/j.jaad.2017.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/18/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Dorota Z Korta
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Angela M Christiano
- Departments of Dermatology and Genetics and Development, Columbia University, New York, New York
| | - Wilma Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abby Ellison
- National Alopecia Areata Foundation, San Rafael, California
| | - Jennifer Fu
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Maria K Hordinsky
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Brett King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Dory Kranz
- National Alopecia Areata Foundation, San Rafael, California
| | - Julian Mackay-Wiggan
- Departments of Dermatology and Genetics and Development, Columbia University, New York, New York
| | - Amy McMichael
- Department of Dermatology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - David A Norris
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vera Price
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Natasha Atanaskova Mesinkovska
- Department of Dermatology, University of California Irvine, Irvine, California; National Alopecia Areata Foundation, San Rafael, California.
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4
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de Jong A, Jabbari A, Dai Z, Xing L, Lee D, Li MM, Duvic M, Hordinsky M, Norris DA, Price V, Mackay-Wiggan J, Clynes R, Christiano AM. High-throughput T cell receptor sequencing identifies clonally expanded CD8+ T cell populations in alopecia areata. JCI Insight 2018; 3:121949. [PMID: 30282836 DOI: 10.1172/jci.insight.121949] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/29/2018] [Indexed: 01/04/2023] Open
Abstract
Alopecia areata (AA) is an autoimmune disease in which cytotoxic T cells specifically target growing hair follicles. We used high-throughput TCR sequencing in the C3H/HeJ mouse model of AA and in human AA patients to gain insight into pathogenic T cell populations and their dynamics, which revealed clonal CD8+ T cell expansions in lesional skin. In the C3H/HeJ model, we observed interindividual sharing of TCRβ chain protein sequences, which strongly supports a model of antigenic drive in AA. The overlap between the lesional TCR repertoire and a population of CD8+NKG2D+ T cells in skin-draining lymph nodes identified this subset as pathogenic effectors. In AA patients, treatment with the oral JAK inhibitor tofacitinib resulted in a decrease in clonally expanded CD8+ T cells in the scalp but also revealed that many expanded lesional T cell clones do not completely disappear from either skin or blood during treatment with tofacitinib, which may explain in part the relapse of disease after stopping treatment.
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Affiliation(s)
| | | | | | - Luzhou Xing
- Department of Pathology, Columbia University, New York, New York, USA
| | | | | | - Madeleine Duvic
- Department of Dermatology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - David A Norris
- Department of Dermatology, University of Colorado, Denver, Colorado, USA
| | - Vera Price
- Department of Dermatology, UCSF, San Francisco, California, USA
| | | | | | - Angela M Christiano
- Department of Dermatology and.,Department of Genetics and Development, Columbia University, New York, New York, USA
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5
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Jabbari A, Sansaricq F, Cerise J, Chen JC, Bitterman A, Ulerio G, Borbon J, Clynes R, Christiano AM, Mackay-Wiggan J. An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis. J Invest Dermatol 2018; 138:1539-1545. [PMID: 29452121 DOI: 10.1016/j.jid.2018.01.032] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/09/2018] [Accepted: 01/26/2018] [Indexed: 01/14/2023]
Abstract
Alopecia areata (AA) is a common autoimmune disease with a lifetime risk of ∼2%. In AA, the immune system targets the hair follicle, resulting in clinical hair loss. The prognosis of AA is unpredictable, and currently there is no definitive treatment. Our previous whole genome expression studies identified active immune circuits in AA lesions, including common γ-chain cytokine and IFN pathways. Because these pathways are mediated through JAK kinases, we prioritized clinical exploration of small molecule JAK inhibitors. In preclinical trials in mice, tofacitinib successfully prevented AA development and reversed established disease. In our tofacitinib trial in 12 patients with moderate to severe AA, 11 patients completed a full course of treatment with minimal adverse events. Following limited response to the initial dose (5 mg b.i.d.), the dose was escalated (10 mg b.i.d.) for nonresponding subjects. Eight of 12 patients demonstrated ≥50% hair regrowth, while three patients demonstrated <50% hair regrowth, as measured by Severity in Alopecia Tool scoring. One patient demonstrated no regrowth. Gene expression profiles and Alopecia Areata Disease Activity Index scores correlated with clinical response. Our open-label studies of ruxolitinib and tofacitinib have shown dramatic clinical responses in moderate to severe AA, providing strong rationale for larger clinical trials using JAK inhibitors in AA. ClinicalTrials.gov ID NCT02299297.
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Affiliation(s)
- A Jabbari
- Department of Dermatology, Columbia University, New York, New York, USA; Department of Dermatology and Interdisciplinary Program in Immunology, University of Iowa, Iowa City, Iowa, USA
| | - F Sansaricq
- Department of Dermatology, Columbia University, New York, New York, USA
| | - J Cerise
- Department of Dermatology, Columbia University, New York, New York, USA
| | - J C Chen
- Department of Dermatology, Columbia University, New York, New York, USA
| | - A Bitterman
- Department of Dermatology, Columbia University, New York, New York, USA
| | - G Ulerio
- Department of Dermatology, Columbia University, New York, New York, USA
| | - J Borbon
- Department of Dermatology, Columbia University, New York, New York, USA
| | - R Clynes
- Department of Dermatology, Columbia University, New York, New York, USA; Department of Genetics, Columbia University, New York, New York, USA; Department of Pathology, Columbia University, New York, New York, USA; Department of Medicine, Columbia University, New York, New York, USA
| | - A M Christiano
- Department of Dermatology, Columbia University, New York, New York, USA
| | - J Mackay-Wiggan
- Department of Dermatology, Columbia University, New York, New York, USA.
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6
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Jabbari A, Nguyen N, Cerise JE, Ulerio G, de Jong A, Clynes R, Christiano AM, Mackay-Wiggan J. Treatment of an alopecia areata patient with tofacitinib results in regrowth of hair and changes in serum and skin biomarkers. Exp Dermatol 2018; 25:642-3. [PMID: 27119625 DOI: 10.1111/exd.13060] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Ali Jabbari
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Nhan Nguyen
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Jane E Cerise
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Grace Ulerio
- Department of Dermatology, Columbia University, New York, NY, USA
| | | | - Raphael Clynes
- Department of Dermatology, Columbia University, New York, NY, USA
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7
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de Jong A, Jabbari A, Dai Z, Xing L, Lee D, Price V, Duvic M, Norris D, Hordinsky M, Mackay-Wiggan J, Clynes R, Christiano A. 052 Identification of pathogenic T cell subsets in human alopecia areata. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Jabbari A, Cerise J, Chen J, Sansaricq F, Clynes R, Christiano A, Mackay-Wiggan J. 331 An open label clinical trial of the JAK inhibitor tofacitinib for alopecia areata. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Mackay-Wiggan J, Jabbari A, Nguyen N, Cerise JE, Clark C, Ulerio G, Furniss M, Vaughan R, Christiano AM, Clynes R. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight 2016; 1:e89790. [PMID: 27699253 DOI: 10.1172/jci.insight.89790] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND. Alopecia areata (AA) is a common autoimmune disease with a lifetime risk of 1.7%; there are no FDA-approved treatments for AA. We previously identified a dominant IFN-γ transcriptional signature in cytotoxic T lymphocytes (CTLs) in human and mouse AA skin and showed that treatment with JAK inhibitors induced durable hair regrowth in mice by targeting this pathway. Here, we investigated the use of the oral JAK1/2 inhibitor ruxolitinib in the treatment of patients with moderate-to-severe AA. METHODS. We initiated an open-label clinical trial of 12 patients with moderate-to-severe AA, using oral ruxolitinib, 20 mg twice per day, for 3-6 months of treatment followed by 3 months follow-up off drug. The primary endpoint was the proportion of subjects with 50% or greater hair regrowth from baseline to end of treatment. RESULTS. Nine of twelve patients (75%) demonstrated a remarkable response to treatment, with average hair regrowth of 92% at the end of treatment. Safety parameters remained largely within normal limits, and no serious adverse effects were reported. Gene expression profiling revealed treatment-related downregulation of inflammatory markers, including signatures for CTLs and IFN response genes and upregulation of hair-specific markers. CONCLUSION. In this pilot study, 9 of 12 patients (75%) treated with ruxolitinib showed significant scalp hair regrowth and improvement of AA. Larger randomized controlled trials are needed to further assess the safety and efficacy of ruxolitinib in the treatment of AA. TRIAL REGISTRATION. Clinicaltrials.gov NCT01950780. FUNDING. Locks of Love Foundation, the Alopecia Areata Initiative, NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the Irving Institute for Clinical and Translational Research/Columbia University Medical Center Clinical and Translational Science Award (CUMC CTSA).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Angela M Christiano
- Department of Dermatology.,Department of Genetics and Development, Columbia University, New York, New York, USA
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10
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Jabbari A, Cerise J, Chen J, Ulerio G, Sidharthan S, Borbon J, Mackay-Wiggan J, Clynes R, Christiano A. 546 Gene expression signatures and ALADIN score correlates with response of alopecia areata patients to treatment with JAK inhibitors. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Cerise J, Jabbari A, Petukhova L, Duvic M, Hordinsky M, Norris D, Price V, Mackay-Wiggan J, Clynes R, Christiano A. 399 Expression quantitative trait loci (eQTL) mapping in a multicenter cross-sectional study of Alopecia Areata. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Jabbari A, Cerise JE, Chen JC, Mackay-Wiggan J, Duvic M, Price V, Hordinsky M, Norris D, Clynes R, Christiano AM. Molecular signatures define alopecia areata subtypes and transcriptional biomarkers. EBioMedicine 2016; 7:240-7. [PMID: 27322477 PMCID: PMC4909368 DOI: 10.1016/j.ebiom.2016.03.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 01/24/2023] Open
Abstract
Alopecia areata (AA) is an autoimmune disease typified by nonscarring hair loss with a variable clinical course. In this study, we conducted whole genome gene expression analysis of 96 human scalp skin biopsy specimens from AA or normal control subjects. Based on gene expression profiling, samples formed distinct clusters based on the presence or absence of disease as well as disease phenotype (patchy disease compared with alopecia totalis or universalis). Differential gene expression analysis allowed us to robustly demonstrate graded immune activity in samples of increasing phenotypic severity and generate a quantitative gene expression scoring system that classified samples based on interferon and cytotoxic T lymphocyte immune signatures critical for disease pathogenesis. Gene expression analysis of 96 scalp biopsies from patients with alopecia areata (AA) and healthy controls was performed. Samples from AA patchy, alopecia universalis/totalis and control patients formed distinct clusters by gene expression. A set of gene expression biomarkers, the Alopecia Areata Disease Activity Index (ALADIN), was formulated. ALADIN distinguished AA phenotypes and normal controls. ALADIN may have utility in clinical trials of AA.
Alopecia areata is a disease characterized by autoimmune attack of the hair follicle. A complete understanding of the signaling pathways involved in the disease is lacking. Based on gene expression profiling of skin samples from 96 patients and controls, a set of biomarkers, termed the Alopecia Areata Disease Activity Index, or ALADIN, was formulated. ALADIN was able to distinguish samples from patients with patchy disease from samples from patients with the more extensive forms of disease. The usefulness of this biomarker tool is ready to be assessed in clinical trials of therapeutics for alopecia areata.
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Affiliation(s)
- Ali Jabbari
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Jane E Cerise
- Department of Dermatology, Columbia University, New York, NY, USA
| | - James C Chen
- Department of Dermatology, Columbia University, New York, NY, USA; Department of Systems Biology, Columbia University, New York, USA
| | | | - Madeleine Duvic
- Department of Dermatology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Vera Price
- Department of Dermatology, UCSF, San Francisco, CA, USA
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - David Norris
- Department of Dermatology, University of Colorado, Denver, CO, USA
| | - Raphael Clynes
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Angela M Christiano
- Department of Dermatology, Columbia University, New York, NY, USA; Department of Genetics & Development, Columbia University, New York, NY, USA
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13
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Harris JE, Rashighi M, Nguyen N, Jabbari A, Ulerio G, Clynes R, Christiano AM, Mackay-Wiggan J. Rapid skin repigmentation on oral ruxolitinib in a patient with coexistent vitiligo and alopecia areata (AA). J Am Acad Dermatol 2015; 74:370-1. [PMID: 26685721 DOI: 10.1016/j.jaad.2015.09.073] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022]
Affiliation(s)
- John E Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Mehdi Rashighi
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nhan Nguyen
- Department of Dermatology, Columbia University, New York, NY
| | - Ali Jabbari
- Department of Dermatology, Columbia University, New York, NY
| | - Grace Ulerio
- Department of Dermatology, Columbia University, New York, NY
| | - Raphael Clynes
- Department of Dermatology, Columbia University, New York, NY
| | - Angela M Christiano
- Department of Dermatology, Columbia University, New York, NY; Department of Genetics, Columbia University, New York, NY
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14
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Betz RC, Petukhova L, Ripke S, Huang H, Menelaou A, Redler S, Becker T, Heilmann S, Yamany T, Duvic M, Hordinsky M, Norris D, Price VH, Mackay-Wiggan J, de Jong A, DeStefano GM, Moebus S, Böhm M, Blume-Peytavi U, Wolff H, Lutz G, Kruse R, Bian L, Amos CI, Lee A, Gregersen PK, Blaumeiser B, Altshuler D, Clynes R, de Bakker PIW, Nöthen MM, Daly MJ, Christiano AM. Genome-wide meta-analysis in alopecia areata resolves HLA associations and reveals two new susceptibility loci. Nat Commun 2015; 6:5966. [PMID: 25608926 PMCID: PMC4451186 DOI: 10.1038/ncomms6966] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/25/2014] [Indexed: 12/21/2022] Open
Abstract
Alopecia areata (AA) is a prevalent autoimmune disease with 10 known susceptibility loci. Here we perform the first meta-analysis of research on AA by combining data from two genome-wide association studies (GWAS), and replication with supplemented ImmunoChip data for a total of 3,253 cases and 7,543 controls. The strongest region of association is the major histocompatibility complex, where we fine-map four independent effects, all implicating human leukocyte antigen-DR as a key aetiologic driver. Outside the major histocompatibility complex, we identify two novel loci that exceed the threshold of statistical significance, containing ACOXL/BCL2L11(BIM) (2q13); GARP (LRRC32) (11q13.5), as well as a third nominally significant region SH2B3(LNK)/ATXN2 (12q24.12). Candidate susceptibility gene expression analysis in these regions demonstrates expression in relevant immune cells and the hair follicle. We integrate our results with data from seven other autoimmune diseases and provide insight into the alignment of AA within these disorders. Our findings uncover new molecular pathways disrupted in AA, including autophagy/apoptosis, transforming growth factor beta/Tregs and JAK kinase signalling, and support the causal role of aberrant immune processes in AA.
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Affiliation(s)
- Regina C Betz
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Lynn Petukhova
- Department of Dermatology, Columbia University, NY, NY.,Department of Epidemiology, Columbia University, NY, NY
| | - Stephan Ripke
- Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Hailiang Huang
- Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Androniki Menelaou
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Silke Redler
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Tim Becker
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn
| | - Stefanie Heilmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life&Brain Center, University Bonn, Bonn, Germany
| | - Tarek Yamany
- Department of Dermatology, Columbia University, NY, NY
| | - Madeliene Duvic
- Department of Dermatology, MD Anderson Cancer Center, Houston,TX
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | - David Norris
- Department of Dermatology, University of Colorado, Denver, CO, US
| | - Vera H Price
- Department of Dermatology, University of California, San Francisco, San Francisco CA
| | | | | | - Gina M DeStefano
- Department of Genetics & Development, Columbia University, NY, NY
| | - Susanne Moebus
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans Wolff
- Department of Dermatology, University of Munich, Munich, Germany
| | - Gerhard Lutz
- Dermatological Practice, Hair and Nail, Wesseling, Germany
| | | | - Li Bian
- Department of Dermatology, Columbia University, NY, NY
| | - Christopher I Amos
- Community and Family Medicine and Genetics, Dartmouth College, Hanover, NH, US
| | - Annette Lee
- The Feinstein Institute for Medical Research, Manhasset NY
| | | | | | - David Altshuler
- Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Raphael Clynes
- Department of Dermatology, Columbia University, NY, NY.,Department of Medicine Columbia University, NY, NY
| | - Paul I W de Bakker
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life&Brain Center, University Bonn, Bonn, Germany
| | - Mark J Daly
- Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Angela M Christiano
- Department of Dermatology, Columbia University, NY, NY.,Department of Genetics & Development, Columbia University, NY, NY
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15
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Thompson BJ, Furniss M, Zhao W, Chakraborty B, Mackay-Wiggan J. An oral phosphodiesterase inhibitor (apremilast) for inflammatory rosacea in adults: a pilot study. JAMA Dermatol 2015; 150:1013-4. [PMID: 25054629 DOI: 10.1001/jamadermatol.2013.10526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Megan Furniss
- Department of Dermatology, Columbia University, New York, New York
| | - Wenjing Zhao
- Department of Biostatistics, Columbia University, New York, New York
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16
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Mackay-Wiggan J, Marji J, Walt JG, Campbell A, Coppola C, Chakraborty B, Hollander DA, Whitcup SM. Topical cyclosporine versus emulsion vehicle for the treatment of brittle nails: a randomized controlled pilot study. J Drugs Dermatol 2014; 13:1232-1239. [PMID: 25607558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Limited options are available for the treatment of brittle nail syndrome. OBJECTIVE To assess the efficacy and safety of topical cyclosporine emulsion (CsAE) versus emulsion (vehicle) alone in the treatment of brittle nail syndrome. RESULTS Twenty-four patients were randomized to topical CsAE emulsion or emulsion (vehicle) for 24 weeks. Four fingernails of each patient were included; the 2 most severe brittle nails and the second most normal nail were treated with the same medication. The fourth nail, the most normal nail, remained untreated and was used to assess nail growth. The prespecified primary endpoint was change from baseline in Physician Global Assessment (PGA) score (0 to 5 scale) at each follow-up visit. Safety evaluations were conducted at each visit. RESULTS In the intent-to-treat population (n=12 for each treatment arm), the PGA score for treated nails improved from baseline (CsAE, 0.7 to 1.4; emulsion, 0.7 to 1.5; P<0.05 for each), with no significant between-group differences. Untreated nails did not improve in overall appearance (0.0 to 0.3 grade; P>0.05). Statistically and clinically significant improvement from baseline was reported for nail length/appearance in both CsAE and vehicle groups. LIMITATIONS Sample size was relatively small. The difference in PGA between treated and untreated nails was not analyzed. Baseline disease severity may have been too mild, limiting detection of efficacy. CONCLUSIONS Both CsAE and emulsion vehicle applied topically appeared to improve signs and symptoms of brittle nail syndrome and were well tolerated. These findings warrant corroboration in a larger population and inclusion of comparison with an inactive control and a higher concentration of CsAE, the former which may help in distinguishing the efficacy of vehicle emulsion from CsAE.
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Marji JS, Marcus R, Moennich J, Mackay-Wiggan J. Use of biologic agents in pediatric psoriasis. J Drugs Dermatol 2010; 9:975-986. [PMID: 20684148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Psoriasis affects approximately 2 percent of the population. Approximately 30-45 percent of those affected first experience symptoms during childhood or adolescence. Although biologics have proven to be a relatively safe and effective treatment option for adults with psoriasis, limited information is available regarding the use of biologic agents in pediatric patients with psoriasis. The authors attempt to assess and summarize the available data on the use of biologic agents in patients under the age of 18, regardless of the indication, as well as to examine the limited available data on the use of biologics for psoriasis in the pediatric population. In doing so, the authors aim to provide guidance on the safety and efficacy of biologic therapies in pediatric patients with psoriasis. The authors' findings suggest that biologic agents should be considered for use solely in children with psoriasis that is refractory to conventional therapies, including children currently with severe, widespread, refractory pustular, plaque or psoriatic arthritis. Of all the currently available biologics, etanercept appears to have resulted in fewer and less severe side effects compared to infliximab in the juvenile rheumatoid arthritis population. In addition, while biologics are generally safe and effective in the pediatric population, serious adverse events (including infection), have been reported in the literature and should be taken into account before beginning treatment with any biologic agent. The physician and parents of the patient must carefully consider the risk-benefit ratio when deciding whether to use these medications. Additional randomized, controlled trials are needed to adequately assess the safety and efficacy of biologic medications for childhood psoriasis.
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Affiliation(s)
- Jackleen S Marji
- Department of Dermatology, Columbia University Medical Center, New York, NY 10032, USA
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Mackay-Wiggan J, Nair KG, Halasz CLG. Onycholysis associated with paclitaxel. Cutis 2003; 71:229-32. [PMID: 12661751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Chemotherapeutic agents are known to cause a myriad of cutaneous side effects that the dermatologist is often called upon to identify and treat. The taxoid drug paclitaxel is commonly used in oncology. To date, there have been few adverse dermatologic effects reported secondary to paclitaxel use. This is in contrast to the related drug docetaxel. We report a case in which paclitaxel caused onycholysis and nail loss in a patient being treated for lung cancer. To our knowledge, this finding has not previously been reported in the American dermatologic literature, though it has been reported in association with docetaxel use. It is important for clinicians to recognize that onycholysis can be associated with paclitaxel. Prompt recognition may prevent the unnecessary use of antibiotics or antifungal medications. Discontinuation of paclitaxel chemotherapy generally is not required, and regrowth of nails can be expected following completion of therapy.
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Affiliation(s)
- Julian Mackay-Wiggan
- Department of Dermatology, Columbia University-New York Presbyterian Hospital, New York, USA
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