Blood endotyping distinguishes the profile of vitiligo from that of other inflammatory and autoimmune skin diseases.

Abstract

BACKGROUND:

Peripheral blood skin-homing/cutaneous lymphocyte antigen (CLA)+ T cells emerge as biomarkers of cutaneous immune activation in patients with inflammatory skin diseases (atopic dermatitis [AD] and alopecia areata [AA]). However, blood phenotyping across these subsets is not yet available in patients with vitiligo.

OBJECTIVE:

We sought to measure cytokine production by circulating skin-homing (CLA+) versus systemic (CLA-) "polar" CD4+/CD8+ ratio and activated T-cell subsets in patients with vitiligo compared with patients with AA, AD, or psoriasis and control subjects.

METHODS:

Flow cytometry was used to measure levels of the cytokines IFN-γ, IL-13, IL-9, IL-17, and IL-22 in CD4+/CD8+ T cells in the blood of 19 patients with moderate-to-severe nonsegmental/generalized vitiligo, moderate-to-severe AA (n = 32), psoriasis (n = 24), or AD (n = 43) and control subjects (n = 30). Unsupervised clustering differentiated subjects into groups based on cellular frequencies.

RESULTS:

Patients with Vitiligo showed the highest CLA+/CLA- TH1/type 1 cytotoxic T-cell polarization, with parallel TH2/TH9/TH17/TH22 level increases to levels often greater than those seen in patients with AA, AD, or psoriasis (P < .05). Total regulatory T-cell counts were lower in patients with vitiligo than in control subjects and patients with AD or psoriasis (P < .001). Vitiligo severity correlated with levels of multiple cytokines (P < .1), whereas duration was linked with IFN-γ and IL-17 levels (P < .04). Patients and control subjects grouped into separate clusters based on blood biomarkers.

CONCLUSIONS:

Vitiligo is characterized by a multicytokine polarization among circulating skin-homing and systemic subsets, which differentiates it from other inflammatory/autoimmune skin diseases. Future targeted therapies should delineate the relative contribution of each cytokine axis to disease perpetuation.

• Authors: Tali Czarnowicki, Helen He, Alexandra Leonard, Hyun Je Kim, Naoya Kameyama, Ana B Pavel, Randall Li, Yeriel Estrada, Huei-Chi Wen, Grace W Kimmel, Hee J Kim, Margot Chima, Mark Lebwohl, James G Krueger, Emma Guttman-Yassky
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 143 Issue 6 Pg. 2095-2107 (06 2019) ISSN: 1097-6825 [Electronic] United States
• PMID: 30576756 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• 6-sulfo sialyl Lewis X
• Biomarkers
• Cytokines
• Oligosaccharides
• Sialyl Lewis X Antigen

Topics

• Adult
• Aged
• Aged, 80 and over
• Alopecia Areata (diagnosis)
• Biomarkers (blood)
• Cytokines (blood)
• Dermatitis, Atopic (diagnosis)
• Diagnosis, Differential
• Disease Progression
• Female
• Flow Cytometry
• Humans
• Inflammation
• Male
• Middle Aged
• Oligosaccharides (metabolism)
• Sialyl Lewis X Antigen (analogs & derivatives, metabolism)
• Skin (immunology)
• Th1 Cells (immunology)
• Th2 Cells (immunology)
• Vitiligo (diagnosis)