The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland.
The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
Front Immunol. 2022 Jun 3;13:890027. doi: 10.3389/fimmu.2022.890027. eCollection 2022.
Alopecia areata (AA) is a chronic, multifactorial, polygenic, and heterogeneous disorder affecting growing hair follicles in susceptible individuals, which results in a non-scarring and reversible hair loss with a highly unpredictable course. Despite very considerable research effort, the nature of the precipitating factor(s) responsible for initiating AA in any given hair follicle remains unclear, due largely to significant gaps in our knowledge of the precise sequence of the etiopathogenic events in this dermatosis. However, disease-related changes in the immune-competence of the lower growing hair follicle, together with an active immune response (humoral and cellular) to hair follicle-associated antigens, are key associated phenomena. Confirmation of the hair follicle antigen(s) implicated in AA disease onset has remained stubbornly elusive. While it may be considered somewhat philosophical by some, it is also unclear whether immune-mediated hair loss in AA results from a) an ectopic (i.e., in an abnormal location) immune response to native (unmodified) self-antigens expressed by the healthy hair follicle, b) a normal immune response against modified self-antigens (or neoantigens), or c) a normal immune response against self-antigens (modified/non-modified) that were not previously visible to the immune system (because they were conformationally-hidden or sequestered) but become exposed and presentable in an MHC-I/-II molecule-restricted manner. While some candidate hair follicle antigen target(s) in AA are beginning to emerge, with a potential role for trichohyalin, it is not yet clear whether this represents the and antigenic focus in AA or is simply one of an expanding repertoire of exposed hair follicle tissue damage-associated antigens that are secondary to the disease. Confirmation of autoantigen identity is essential for our understanding of AA etiopathogenesis, and consequently for developing a more informed therapeutic strategy. Major strides have been made in autoantigen discovery in other autoimmune conditions. In particular, some of these conditions may provide insights into how post-translational modifications (e.g., citrullination, deamidation, etc.) of hair follicle-restricted proteins may increase their antigenicity and so help drive the anti-hair follicle immune attack in AA.
斑秃(AA)是一种慢性、多因素、多基因和异质性疾病,影响易感个体的生长毛囊,导致非瘢痕性和可逆转的毛发脱落,且具有高度不可预测的病程。尽管进行了大量研究,但导致任何特定毛囊中 AA 起始的诱发因素的性质仍不清楚,这主要是由于我们对这种皮肤病的发病机制的确切序列的知识存在显著差距。然而,与疾病相关的下部生长毛囊的免疫能力变化,以及对毛囊相关抗原的主动免疫反应(体液和细胞),是关键的相关现象。导致 AA 疾病发作的毛囊抗原的确认仍然难以捉摸。虽然这在某些人看来可能有些哲学性,但也不清楚 AA 中的免疫介导性脱发是由于:a)对健康毛囊表达的天然(未修饰)自身抗原的异位(即异常位置)免疫反应;b)针对修饰自身抗原(或新抗原)的正常免疫反应;还是 c)针对以前免疫系统无法识别的自身抗原(因为它们构象隐藏或被隔离)的正常免疫反应,但以 MHC-I/-II 分子受限的方式暴露和呈现。虽然 AA 中的一些候选毛囊抗原靶标(例如,毛角蛋白)开始出现,但尚不清楚这是否代表 AA 中的抗原焦点,还是仅仅是疾病后暴露和呈现的扩大的暴露毛囊组织损伤相关抗原谱的一部分。自身抗原身份的确认对于我们理解 AA 的发病机制至关重要,因此对于制定更明智的治疗策略至关重要。在其他自身免疫性疾病中,在自身抗原发现方面取得了重大进展。特别是,这些疾病中的一些可能为我们提供有关翻译后修饰(例如,瓜氨酸化、脱酰胺化等)如何增加毛囊受限蛋白的抗原性,从而有助于驱动 AA 中的抗毛囊免疫攻击的见解。