Alopecia areata is characterised by dysregulation in systemic type 17 and type 2 cytokines, which may contribute to disease-associated psychological morbidity

Bain, K. A. et al. (2019) Alopecia areata is characterised by dysregulation in systemic type 17 and type 2 cytokines, which may contribute to disease-associated psychological morbidity. British Journal of Dermatology, (doi:10.1111/bjd.18008) (PMID:30980732) (Early Online Publication)

Abstract

Background: Alopecia areata (AA) is a common autoimmune disease, causing patchy hair loss that can progress to involve the entire scalp (totalis) or body (universalis). CD8+NKG2D+ T cells dominate hair follicle pathogenesis, but the specific mechanisms driving hair loss are not fully understood. Objectives To provide a detailed insight into the systemic cytokine signature associated with AA, and assess the association between cytokines and depression. Methods: Multiplex analysis of plasma cytokines from AA patients, psoriatic arthritis (PsA) patients and healthy controls. We also assessed incidence of depression and anxiety using the Hospital Anxiety and Depression Scale. Results: Our analysis identified a systemic inflammatory signature associated with AA, characterised by elevated levels of IL-17A, IL-17F, IL-21 and IL-23 indicative of a type 17 immune response. Circulating levels of the type 2 cytokines IL-33, IL-31 and IL-17E/25 are also significantly increased in AA. In comparison to PsA, AA was associated with higher levels of IL-17F, IL-17E and IL-23. We hypothesised that circulating inflammatory cytokines may contribute to wider comorbidities associated with AA. We assessed psychiatric comorbidity in AA using the Hospital Anxiety and Depression Scale and found that 18% and 51% of people with AA experienced symptoms of depression and anxiety, respectively. Using linear regression modelling, we identified that levels of IL-22 and IL-17E are positively and significantly associated with depression. Conclusion: Our data highlight changes in both type 17 and 2 cytokines, suggesting that complex systemic cytokine profiles may contribute both to the pathogenesis of AA and to the associated depression.

• Item Type: Articles
• Additional Information: The study was funded by a PhD studentship grant from Medical Research Scotland that was part funded by Astra Zeneca. We also received funding from Alopecia UK to support the alopecia research clinic. Funding for the psoriatic arthritis study was provided by a grant from Versus Arthritis to AB and SM.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McInnes, Professor Iain and McDonald, Mrs Elaine and Milling, Professor Simon and Ijaz, Dr Umer Zeeshan and Cavanagh, Professor Jonathan and Bain, Kym
• Authors: Bain, K. A., McDonald, E., Moffat, F., Tutino, M., Castelino, M., Barton, A., Cavanagh, J., Ijaz, U. Z., Siebert, S., McInnes, I. B., Astrand, A., Holmes, S., and Milling, S. W.F.
• College/School: College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences; College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation; College of Science and Engineering > School of Engineering > Infrastructure and Environment
• Journal Name: British Journal of Dermatology
• Publisher: Wiley
• ISSN: 0007-0963
• ISSN (Online): 1365-2133
• Published Online: 13 April 2019
• Copyright Holders: Copyright © 2019 Wiley
• First Published: First published in British Journal of Dermatology 2019
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher